ADAPTATION MODELBY SISTER CALLISTA ROY, RN, PH.D

Born on October 14, 1939

Conceptual Framework

The Roy Adaptation Model for Nursing had its beginning when Sister Callista Roy entered the masters program in pediatric nursing at University of California, Los Angeles in 1964. Her adviser and senior faculty was Ms. Dorothy Johnson who was writing and speaking on the need to define the goal of nursing as a way of focusing the development of knowledge for practice. Dr. Roy had read a little about the concept of adaptation and was impressed with the resiliency of children she had cared for in pediatrics. At the first seminar in pediatric nursing, she proposed that the goal of nursing was promoting patient adaptation. Throughout her course work in master’s program Dorothy Johnson encouraged her to develop her concept of adaptation as a framework for nursing. Like Helson, the use of systems theory as defined by von Bertalanffy was an important early concept of the model. Helson defined adaptation as a process of responding positively to environmental changes and described three types of stimuli: focal, contextual and residual. Dr. Roy made appropriate derivations of these concepts for use in describing situations of people in health and illness.

The Adaptation Model conceptualizes the person in a holistic perspective. Individual aspects of parts act together to form a unified being. The constant interaction of the people with the environment is characterized by both internal and external changes.

Within the changing world, the person must maintain his own integrity and is able to adopt.

The Adaptive System has input, coming from the external environment as well as input coming from a person. Roy identifies input as stimuli. A stimulus is described as a unit of information matter or energy from the environment or from with in the person that elicits a response. Along with the stimulus, the adaptation level of the person acts as input to that person as an adaptive system.

3 Classifications of Stimuli Focal stimuli-demands the highest awareness from the

human system. It is the center of system’s consciousness. The stimulus most immediately confronting the person like decrease blood and oxygen supply.

Contextual stimuli-are all other stimuli of the human system’s internal and external worlds that can be identified as having a positive or negative influence on the situation. These stimuli can be observable, measurable, or subjectively reported by person. These include increased temperature, on and off pain, age, weight, and changes in the vital signs and blood chemistry.

Residual stimuli-are environmental factors within or without the human system with effects in the current situation that are unclear. Like exposure to cigarette smoking, high fat diet, coffee drinking, usage of illegal drugs, or over the counter drugs and previous infection.

3 Levels of Adaptation Integrated processes- are present when the adaptation

level is working as a whole to meet the needs of the human system.

Compensatory processes-occur when the humans response systems have been activated.

Compromised processes-occur when the compensatory and integrated processes are not providing for adaptation.

Coping Mechanism- to describe the control processes of the human as an adaptive system.

Regulator subsystem-a major coping process involving the neural, chemical, and endocrine system in nature.

Cognator subsystem-is a major coping process involving the four cognitive-emotive channels: Perceptual and information processing, learning, judgment, and emotion. To maintain integrity, the people most have maximal use of his coping mechanisms to broaden his adaptive level.

The Four Adaptive Modes Physiological Function Mode-is associated with the

physical and chemical processes involved in the function and

activities of living organisms. It includes the oxygenation, nutrition, elimination, activity and rest, skin integrity, senses, fluids and electrolytes, neurological function and endocrine function. It refers to the patient response as a physical being to the environmental.

Self-concept mode- consists of the individual’s feelings, values and beliefs at a given point in time that influence behavior. This includes psychic, integrity, physical self, self-consistency, moral-ethical-spiritual self and self-esteem formed by the patient about himself.

Role Function mode- focuses on the roles the person occupies in society. This includes position, performance social integrity in the primary, secondary, and tertiary roles within the home, job and community.

Interdependence mode-focuses on the giving and receiving of love, respect, nurturing, knowledge, skills and value with significant others and support systems. These processes occur through interpersonal on both individual and group levels.

Output behaviors of the person which can be both external and internal, maybe observed, measured or subjectively reported. They become feedback to the system and to the environment.

Adaptive responses-are those that promote the integrity or wholeness of the person especially when he is able to meet the goals in terms of survival, growth, reproduction and mastery.

Ineffective responses-are those that do not contribute to the goals at the human adaptive system.

Scientific Assumptions1. Systems of matter and energy progress to higher levels of

complex self-organization.2. Consciousness and meaning are constitutive of person

and environment integration.3. Awareness of self and environment is rooted in thinking

and feeling.4. Humans by their decisions are accountable for the integration

of creative processes.5. Thinking and feeling mediate human action.

6. System relationships include acceptance, protection, and fostering of interdependence.

7. Persons and the earth have common patterns and integral relationships.

8. Persons and environment transformations are created in human consciousness.

9. Integration of human and environment meanings results in adaptation.

Philosophic Assumptions1. Persons have mutual relationship with the world and

God.2. Human meaning is rooted in an omega point

convergence of the universe.3. God is intimately revealed in the diversity of creation and is

the common destiny of creation.4. Persons use human creative abilities of awareness,

enlightenment, and faith. 5. Persons are accountable for the process of deriving,

sustaining, and transforming the universe.

Human Adaptive System Persons are in constant interaction with their environment.

Between the system and the environment occurs an exchange of information, matter, and energy.

Characteristics of a system include inputs, controls, outputs and feedback.

Environment- all conditions, circumstances, and influences that surround and affect the development and behavior of humans as adaptive systems, with particular consideration of person and earth resources.

Health- a state and a process of being and becoming an integrated and whole human being. (Roy and Andrews, 1999)

Goal of Nursing- is to promote adaptation by managing the environmental stimuli. Nursing activities support adaptive responses and seek to reduce ineffective responses.

Common Stimuli affecting Adaptation1. Culture-socioeconomic status, ethnicity, belief system2. Family/aggregate participants-structure and tasks3. Developmental stage- age, sec, tasks, heredity4. Environmental considerations-change in interval or

external environment medical management, use of drugs, alcohol, tobacco, political or economic stability.

Strengths of RAM1. Focus on and inclusion of the whole person or group2. The four modes provide an opportunity for consideration of

multiple aspects of the human adaptive system and support gaining an understanding of the whole system.

3. The importance of the spiritual aspects of the human adaptive system is included in the manner that allows for incorporation of spirituality with imposition of the nurse's beliefs.

4. It is logically organized and draws on the nurse's observational and interviewing skills.

Weaknesses of RAM1. The need for consistent definitions of the concept and

terms with in the RAM2. The amount of time required to fully implement the two

areas of RAM assessment maybe viewed as insurmountable.

Sample Schematic Diagram of the Study

Assessment of Behavior

Assessment of Stimuli

Diagnosis

Goal Setting(Change ineffective behavior to adaptive behavior)

Implementation(Adaptive Modes)

Evaluation(Adaptive Response)

Application of the theory in the Case Study

Roy’s Adaptation Model in the Post Operative Care of Cholecystectomy Patient

Sample Statement of the Problem in the case study

1. What is the Clinical Profile of the patient in terms of:1.1 Focal Stimuli1.2 Contextual Stimuli1.3 Residual Stimuli

2. What Adaptive Modes were utilized by the patient in terms of:2.1 Physiological Function2.2 Self- Concept Function2.3 Role Function2.4 Interdependence Function

3. What Nursing Diagnoses were identified in the post operative phase?

4. What discharge instructions were given in terms of:4.1 Medication4.2 Exercise4.3 Teachings4.4 Health teaching4.5 Observable signs and symptoms to report4.6 Diet4.7 Spiritual

SAMPLE RESEARCH ASSESSMENT TOOL

A. General Admission Information:

Name of Patient____________Age______Sex_______Status_____Date_____________Time__________Mode______Allergies______TPR ______BP ____Wt. _______ Ht.______Diet______________

B. Admission InterviewI. Perception of Illness

1. Why, initially, did you come to the hospital?2. What does the doctor plan for you while you are here?3. What do you expect to happen to you when you stay at

the hospital?II. History of Past Illness (Include Dates and Hospitalizations)

Medications

Dose Frequency

Last Dose taken

Reason for taking

Do you receive any special treatments or exercises?III. Activity

1. Do you have difficulty walking or getting in and out of a chair?

2. Can you climb stairs?3. Are you employed?4. What are you usual daytime activities?5. What are your recreational interests?

IV. Nutrition1. Are you on a special diet?2. Do you have difficulty following a diet?3. How many meals do you eat a day?

V. Sleep Habits1. Do you sleep through the night at home?2. What helps in getting to sleep at night?3. What are your usual sleeping habits?

VI. Elimination1. How often do you urinate?2. Do you have any difficulty with urination?3. Frequency______Pain on urination____4. Urgency_____Other_____5. Have you ever had urinary tract infection?6. 24-hour urine output______cc/24 hours7. What are your usual bowel habits?8. Do you have difficulty with diarrhea or constipation?9. How often do you use enemas or laxatives?

VII. Reproductive System1. When was your most recent menses?2. Have you recently had change in menses?3. Have you had any changes in sexual function recently?

VIII. Social1. Do you live with anyone?2. Upon whom do you rely when you need help?3. In what type of dwelling do you live?4. Do you have to climb stairs?5. Financial resources/insurance?

IX. Skin Color Turgor Temperature Lesions Condition of nails Edema

X. GeneralPresence of:

Nausea Vomiting Headache Blurring of vision Ability to perform ADL’s

BIBLIOGRAPHY:

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