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SISTER CALLISTA ROY:THE ADAPTATION MODEL

By:

Caroline Gates, RN, BSN

Carol Marrs, RN, BSN

Preethi Unjakoti, RN, BSN

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When I consider your heavens,The work of your fingers…What is man that you are mindful of him,The son of man that you care for him?You made him a little lower than the

heavenly beingsAnd crowned him with glory and honorYou made him ruler over the works of

your hands Psalm 8: 3-6

When I consider your heavens,The work of your fingers…What is man that you are mindful of him,The son of man that you care for him?You made him a little lower than the

heavenly beingsAnd crowned him with glory and honorYou made him ruler over the works of

your hands Psalm 8: 3-6

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Introduction of the Theory and Theorist

Preethi Unjakoti

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Sister Callista Roy

Born in Los Angeles, California, on October 14, 1939

Second child of Mr. and Mrs. Fabien Roy

Family of seven boys and seven girls

She was named after Saint Callistus of the Roman Catholic Calendar.

Mother was a licensed vocational nurse

Roy, Sr. C., Zhan, L., & Parker, M. E., ( 2006). Nursing Theories & Nursing Practice. Second Edition. Philadelphia, PA: F. A Davis Company

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Education

Bachelors Degree in Nursing from Mount St. Mary’s College in 1963.

Masters in Pediatric Nursing fromUniversity of California in 1966

Suffered with Encephalomyelitis, a neurological disorder.

Second Masters and PhD in Sociology in 1973 and

1977

She finished her postdoctoral program in

Neuroscience Nursing.

Roy, Sr. C., Zhan, L., & Parker, M. E., ( 2006). Nursing Theories & Nursing Practice. Second Edition. Philadelphia, PA: F. A Davis Company

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Professional Experience

Started at age 14.Pediatric NurseNursing instructor in many

different capacities.

Currently she is the Professor and Nurse Theorist at the William F. Connell School of Nursing, Boston College.

Roy, Sr. C., Zhan, L., & Parker, M. E., ( 2006). Nursing Theories & Nursing Practice. Second Edition. Philadelphia, PA: F. A Davis Company

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Personal and Professional Influences

Her family, mainly her mother

Her religious beliefs She became a member of the Sister

Of Saint Joseph of Carondelet

Her teachers and mentors

Dr. Dorothy Johnson Challenged Ms. Roy to develop her

Nursing theory. Roy, Sr. C., Zhan, L., & Parker, M. E., ( 2006). Nursing Theories & Nursing Practice. Second Edition. Philadelphia, PA: F. A Davis Company

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Introduction of The Model/Theory

Adaptation was first introduced to Ms. Roy in apsychology class

Adaptation of children

Theory development started in 1964

First utilized in Mount St. Mary’s CollegeAlligood, M. R., & Ann Marriner T., (2010). Nursing theorists and their work. Seventh edition. Maryland Heights, MO: Mosby Elsevier.

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Roy’s Adaptation Model

Developed over the years

Supported through research

163 Research studies conducted

Has been in use for 46 years.

Published in various languages

Internationally used. Alligood, M. R., & Ann Marriner T., (2010). Nursing theorists and their work. Seventh edition. Maryland Heights, MO: Mosby Elsevier.

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Primary Concepts of the Model

Key concepts are the Person (or a group) viewed as a adaptive system, their health, and their environment. A person is a bio-psyco-social being. Both innate and acquired mechanisms are used for

coping.

*******The main concept*******

Assessment of behavior and the factors affecting adaptation, and intervention to promote adaptive abilities and enhance

environmental interactions. Johnson Lutjens, L. R., (1991). Callista Roy: An Adaptation Model. Newbury Park, CA: SAGE Publications, Inc

Retrieved from http://www.bc.edu/schools/son/faculty/featured/theorist/Roy_Adaptation_Model/

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Worldview

Three different worldviews: Rationalism Relativism Veritivity

Veritivity is Ms. Roy’s worldview “It is capable of providing a worldview of cosmic unity, by which persons and environment are integrated and

achieve a final common destiny.”

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Metaparadigm: Person

Person is viewed as a holistic adaptive systemEngaging in and interchanging with the

environmentPerson also refers to families, groups,

communities and the whole society. Andrews, H. A., & Roy, Sr. C., (1999). The Roy Adaptation Model. Stamford, CT: Simon & Schuster Company.

Andrews, H. A., & Roy, Sr. C., (1999). The Roy Adaptation Model. Stamford, CT: Simon & Schuster Company.

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Metaparadigm: Health

Health is the state and a process of being and becoming an integrated and whole person.

It is a process where he or she is striving to achieve their maximum potential.

Andrews, H. A., & Roy, Sr. C., (1999). The Roy Adaptation Model. Stamford, CT: Simon & Schuster Company.

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Metaparadigm: Environment

All conditions, circumstances, and influences.

A change acts as a catalyst and causes adaptive responses.

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Key Definitions

System: A set of parts connected to function as a whole for some purpose.

Coping Processes: Either Innate or acquired ways of interaction.

Regulator Coping: Coping process involving the neural, chemical and endocrine systems.

Cognator Coping: Coping process involving the four cognitive-emotive channels.

Alligood, M. R., & Ann Marriner T., (2010). Nursing theorists and their work. Seventh edition. Maryland Heights, MO: Mosby Elsevier.

Andrews, H. A., & Roy, Sr. C., (1999). The Roy Adaptation Model. Stamford, CT: Simon & Schuster Company.

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Metaparadigm of Nursing

Nursing acts to enhance the interaction of the person with the environment to promote adaptation

It is the science and practice that expands adaptive abilities.

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Key Definitions

Focal Stimulus: The internal or external stimulus most immediately confronting the human system.

Contextual Stimulus: All other stimuli present in the situation that contribute to the behavior of the focal stimuli.

Residual Stimuli: factors that may be affecting behavior but whose effects are not validated.

Alligood, M. R., & Ann Marriner T., (2010). Nursing theorists and their work. Seventh edition. Maryland Heights, MO: Mosby Elsevier.

e

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Key Definitions

Integrity: Degree of wholeness achieved by adapting to changes in needs.

Adaptation Level: A changing point, influenced by the demands of the situation and the person’s internal resources.

Behavior: Actions and reactions under specified circumstances.

Alligood, M. R., & Ann Marriner T., (2010). Nursing theorists and their work. Seventh edition. Maryland Heights, MO: Mosby Elsevier.

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Sister Callista Roy’s

Adaptation Model and

Application

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Person

-Person: adaptive system constantly interacting with external and internal environment

-Persons major task: Maintain personal integrity (wholeness) in face of environmental stimuli.

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Environment4

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Adaptation5

Integrated, Compensatory, or Compromised

Stimuli influence adaptation level

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Roy’s Model Continued…

Coping mechanisms: Regulator and Cognator

Control Processes: Stabilizer and Innovator

ADAPTATION

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Four Adaptive Modes

1. Physiological- oxygenation, nutrition, elimination, activity, rest, and protection

2. Self Concept- Psychological and spiritual elements

3. Role Function- primary,secondary, and tertiary roles the person performs in society

4. Interdependence- coping mechanisms arising from close relationships

Goal: Promote integrated adaptation in all four modes = HEALTH

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Four Adaptation Modes

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Apply the Nursing Process to Each of the Four Adaptive Modes

1. Assess Behavior

2. Assess Stimuli

3. Nursing Diagnosis

4. Goal Setting

5. Interventions

6. Evaluation

ULTIMATE GOAL: Promote integrated adaptation in each of the Four Adaptive Modes

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Visual Aid

Roy’s Adaptation Model

Person-open system

Environmental Stimuli: Focal, Contextual, Residual

Adaptation level: integrated,

compensatory, or compromised.

Health

Nursing

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Examples of Roy’s Model in Practice

Cancer patients -Cook(1999), Gerrish (1989) Amputations - Dawson (1998) Occupational Health -Doyle & Rejacich (1991) Pt’s with Anxiety- Fredrickson (1993) Hospitalized Children- Galligan (1979), Starn & Niederhauser

(1990) Coronary Care Unit- Hamner (1989) Adolescents with Asthma- Hennessy-Harstad (1999) Adult Hemodialysis patients- Keen et al. (1998) Home care- Lankester & Sheldon (1999), Schmitz (1980) Abused Women- Limandri (1986) Patients with Kawasaki disease- Nash (1987) Adolescents with bulimia nervosa- Pilote (1998a,1998b) Elderly in apartment complexes- Smith (1998) Patients with alzheimer’s disease- Thornbury & King (1992)

* List obtained from Fitzpatrick and Wall (2005)

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More recently...Suggested use in Community Health Nursing

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Physical-morbidity/mortality stats, medical facilities, funding

Group identity-culture,morale

Role function-effectiveness and accountability of institutions (fire, police, hospitals)

Interdependence-relationships of community with outside organizations, quality of relationships within the community

* Dixon, E.L. (1999). Community health nursing practice and the Roy adaptation model. Public Health Nursing 16(4), 290-300.

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Use of Roy’s model to promote behavior change...

- Helped women have a more accurate understanding of smoking addiction

-Women were able to explain how stress affected their physical, mental, spiritual self and their relationships with others

In conclusion: More accurate understanding of their addiction and their perceptions of stimuli that produced the desire for them to continue smoking.

* Villareal, E. (2003). Using Roy’s adapation model when caring fpr a group of young women contemplating

quitting smoking. Public Health Nusing, 20(5), 377-384

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Helping Women through Menopause15

Holistic approach to assessing and analyzing the menopausal transition

*Cunningham, D. A. (2003). Application of Roy’s adaptation model when caring for a group of women coping with menopause. Journal of Community Health Nursing, 19(1), 49-60.

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Examples of Roy’s Adaptation Model in Research

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Cross-cultural pain- Cavillo & Flaskerud (1993) Caesarean birth- Fawcett (1990) Child-bearing women- Fawcett & Tulman (1990), Tulman et al.

(1998) Cancer patients- Frederickson et al. (1991), Samarel et al. (1998) Spinal cord injury patients- Harding-Okimoto (1997) Abused women- Limandri (1986) Well adolescents- Modrcin et al. (1998) Breast-feeding women- Nyqvist & Sjoden (1993) Spouses of surgical patients- Silva (1987) Elderly persons- Smith (1988), Zhan (2000) Persons with Alzheimer’s disease- Thornbury and King (1992)

* List obtained from Fitzpatrick and Wall (2005)

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More recently...

Brooke Army Medical Center and U.S. Army Institute of Surgical Research- Series of studies based on Roy’s Adaptation Model

1. Quality of life experienced by people with cancer. Findings: Military patients did not share with their healthcare provider about pain, sexual dysfunciton, ect. because they viewed these as expected.

2 Investigate feasibility of exercise program and examine the effects on physiological and psychological parameters of health in Cancer patients. Findings: Improved exercise tolerance, activity, sleep patterns, and quality of life.

Excellent guide for Quality of Life outcomes in patients with long term illness

• * Yoder, L. H. (2005). Using the Roy adaptation model: A program of research in a military research service. Nursing Science Quarterly 18(4), 321-323.

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Adaptation in Children with Cancer18

Used Roy’s model to guide in data collection in adaptation modes.

Different age groups will adapt differently

Age and physical maturity have significant impact on adaptation to cancer in pediatrics.

• *Yeh, C.H. (2001). Adaptation in children with cancer: Research with Roy’s model. Nursing Science Quarterly 14(2), 141-148.

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Examples of Roy’s model in Education 19

One of the most widely used models in the U. S. for nursing education

Geriatric Nurse-Practitioner Program University of Ottawa School of Nursing,

CanadaMount Saint Mary’s College, Los Angeles

Students deliver care based on Roy’s model http://www.msmc.la.edu/undergraduate-bachelor-programs/nursing/bachelor-of-science.asp

*Source: Fitzpatrick & Wall, 2005

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Roy’s Model Applied to Administration

A research study explains how one hospital implemented Roy’s model to develop :

• A Nursing Philosophy

• Mission Statements

• Standards of Practice

• Job Descriptions

• Performance Planning and an Appraisal System

• A Quality Monitoring System

CONCLUSION: highly integrated system of nursing administration and practice

*Rogers et al.,1991

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Caroline Gates RN

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Evaluation of Model

AdequacyModel developed

from belief based mainly on pediatric clinical observations

Use of Harry Helson’s adaptation theory

(Patton, 2004)

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Evaluation of Model

ClarityAdaptation

-How is it defined?-Who defines it?-How is it evaluated?

Health -Non-specific definition

(Lewis, 1988; Patton, 2004)

predictions

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Evaluation of Model

ClarityAdaptive modes have unclear boundaries -Interrelated by perception

Some use of theoretical jargonGood assessment method

(Lewis, 1988; Patton, 2004)

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Evaluation of Model

Complexity

Abstract and difficult to understand

Concept of Person as an adaptive system

Cognator and regulator subsystems

Not easily operational for research -stimuli create an extensive list of potential variables

Tolson & McIntosh, 1996

Adaptation

Coping Control

Regulator Cognator Stabilizer Innovator

Cognitive Emotional

Output processes

Central processes

Input

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Evaluation of Model

Completeness

Addresses all four concepts of a nursing model (metaparadigm)

Comprehensive and systematic assessment - Observed behavior is reflective of the parts

Focus on the individual -> More of a downstream approach

Smaller perspective

Person = adaptive system-> Little room for humanistic understanding

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Clinical Use of the Model for FNPs in primary care setting

Develops systematic and comprehensive ways of knowing reality

Promotes critical thinking

Focused on the Person -rights, liberty, and

independent actions

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Clinical Use of the Model for FNPs in primary care setting

Helps visualize the nursing process as a dynamic continuum -> the patient’s progress becomes the driving force within the process

Provides guidance for intervention that can enhance quality of life and enhance interaction of the person with the environment

Adaptation to chronic illness Family functioning

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Clinical Use of the Model for FNPs in primary care setting

Limited by the perception of adaptation -> need to identify

client’s perception of the problem

The meanings attached to the experience

Then assist the client in forming realistic goals in coping with the problem

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Clinical Use of the Model with a Geriatric Population

Assess circumstances that might contribute to a premature admission to a long term care facility.

Role reversal Powerlessness Difficulty coping with disability Adaptation of significant other

Farkas , 1981

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Clinical Use of the Model for Cardiac Health

Chest pain, decreased levels of activity, fluid overload, sleep disturbance (physiologic mode)

Fear, anxiety, body image disturbance due to bypass surgery (self-concept mode)

Increased dependency on others (role function)

Relationship needs unmet (interdependence mode)

Self-esteem issues (interdependence mode)

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Conclusion

Research supports Roy’s model as evidence based nursing process

Widely used in different settings and has enduring characteristics (based on system’s theory)(Alligood, 2010)

Updated as knowledge increases and trends change (Alligood, 2010)

In a world of globalization, the model is limited by an egocentric paradigm (Cody, 2006)

Limited by the view that the individual good is the highest good to be achieved (Cody, 2006)

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References33

• Alligood, M. R. (2010). Nursing theory: Utilization and application. Maryland

Heights, MO: Mosby, Inc.• Cody, W. (2006). Philosophical and Theoretical Perspectives for

Advanced Nursing Practice. (4th Ed.). Sudbury, MA: Jones and Bartlett.

• Cunningham, D. A. (2003). Application of Roy’s adaptation model when caring for a

group of women coping with menopause. Journal of Community Health

Nursing, 19(1), 49-60.• Dixon, E.L. (1999). Community health nursing practice and the Roy adaptation

model. Public Health Nursing 16(4), 290-300• Farkas, L. (1981). Adaptation problems with nursing home application for elderly

persons: an application of the Roy adaptation nursing model. Journal of Advanced Nursing (6), 363-368.

• Fitzpatrick, J.J., & Whall A.L. (2005). Conceptual models of nursing: Analysis andapplication. Upper Saddle River, NJ: Pearson Education, Inc.

• Lewis, T. (1988). Leaping the chasm between nursing theory and practice. Journal of Advanced Nursing (13), 345-351.

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References Continued

• Patton, D. (2004). An analysis of Roy’s Adaptation Model of nursing as used within acute psychiatric nursing. Journal of Psychiatric

and Mental Health Nursing (11), 221-228.• Roders, M., Paul, L. J., Clarke, J., Mackay, C., Potter, M., Ward, W. (1991). The use of

the Roy Adaptation Model in nursing administration. Canadian Journal of

Nursing Administration 4 (2), 21-26.• Tolson, D, McIntosh, J. (1996). The Roy Adaptation Model: a consideration of its

properties as a conceptual framework for an intervention study. Journal of

Advanced Nursing (96), 981-987.• Villareal, E. (2003). Using Roy’s adapation model when caring fpr a group of young

women contemplating quitting smoking. Public Health Nusing, 20(5), 377-384

• Yeh, C.H. (2001). Adaptation in children with cancer: Research with Roy’s model. Nursing Science Quarterly 14(2), 141-148.

• Yoder, L. H. (2005). Using the Roy adaptation model: A program of research in a

military research service. Nursing Science Quarterly 18(4), 321-323.