KAHER INSTITUTE OF NURSING

SCIENCES BELAGAVI,KARNATAKA

Sister Callista Roy’s

Adaptation Model

Presented by
Veereshkumar SN
Associate Professor Department
30/07/2020 of Mental Health Nursing
KAHER INS Belagavi
 GRAND THEORIES BASED ON INTERACTIVE PROCESS

• Nursing theories that focused on interactions between the client

and the nurse and between the client and the health care
system.
• In the interaction models and theories, human beings are viewed
as interacting wholes and client problems are seen as
multifactorial.
• Interactions between clients and their environments, both
internal and external, some of which cannot be measured.

• The interactive theories are need theories and grounded in the

postpositive schools of philosophy.

(McEwen, Willis, 2011)

 OUTLINES
• Get a brief introduction of theorist.

• Define the theory and metaparadigm.

• Explain the internal processing subsystems.

• Describe the types of stimuli.

• To know the adaptive modes.

• Is the theory applicable.

• Is the theory practicable.

• Can the theory guide research studies.

• Can the theory used in educational programs.

DR.CALLISTA ROY

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

• Designated as a 2007 living legend by the American
Academy of Nursing.

• Master in Pediatric Nursing from University of

California in 1966.

• Second Master and PhD in Sociology in 1973-

1977.
CONT...
• Dr. Roy also had the opportunity to be a Clinical
Nurse Scholar two year Post-Doctoral program in
Neuroscience at University of California.
• She selected this field to develop her understanding
of the holistic person, especially as an adaptive
system. And because of her familiarity with this
clinical area because of her own neurological
illnesses.
PROFESSIONAL EXPERIENCE

• Nurse Aid at the age of 14.

• Pediatric Nurse.
• Nursing Instructor in many different capacities.
• She has lectured across the United States and
in then thirty other countries.
 Theoretical Sources
• RAM is the derivation of Bertalanf (1968) general system
theory and Harry Helson’s adaptation level theory (1964)
• According to Roy the more than 1500 faculty and students
contributed for the development of adaptation model
• Organized course content according to a view of a person and
family as adaptive system
• As a faculty of mount St.Mery’s college, the model was
implemented in mount Mery’s school as a basis of curriculum
in 1970
• 1971- she was made as the chair of nursing department at the
college
• The model uses concepts from Abraham Maslow to explore
beliefs and values of persons . Roy’s holistic approach based in
humanism
 INTRODUCTION TO THEMODEL/THEORY

Adaptation was first introduced to Dr. in

Roy psychology class. her

Adaptation of children:

While working as a Pediatric nurse, Roy had noticed the

great resiliency of children and their ability to adapt in
response to major physical and psychological changes.

Theory development started in 1964.

12/6/2017
 STATEMENT OF THE THEORY

“The goal of nursing is to promote

adaptation for individuals and groups in
each of the four adaptive modes i.e.
physiological needs, self- concepts, role
function, and interdependent relations
thus contributing to health quality of life,
and dignity with dying”.
 THE ROY ADAPTATION MODEL

• The Roy Adaptation Model (RAM)

focuses on the interrelatedness
of four adaptive systems.
• It is a deductive theory based on
nursing practice.
• The RAM guides the nurse
who is interested in
physiologic & psychosocial
adaptation.

(McEwen, Willis, 2011)

NURSING
• A “theoretical system of
knowledge which prescribes a
process of analysis and action
related to the care of the ill or
potentially ill person.”

• Roy differentiates nursing as a

science from nursing as a
practice discipline.
 • A “biopsychosocial being in
PERSON constant
interaction with a changing environment.”
• The of care, as a living
complex,
recipient nursingsystem with
adaptive (cognator and
processes internal
regulator) acting to
maintain adaptation in the adaptiv
four
modes (physiological needs, self- e
role function, and concept,
interdependence.)
• The person as a living system is “a whole
made up of parts of subsystems that
function as a unity for some purpose.”
HEALT
H • A “state and a process of
being and becoming an
integrated and whole person.
Lack of integration
represents lack of health.”
 ENVIRONMENT
 “all the conditions, circumstances, and influences
surrounding and affecting the development and
behavior of persons or groups. ”
 The input into the person as an adaptive system involving both
internal and external factors (may be slight or large, positive or
negative)
 Any environmental change demands increasing energy to adapt
to the situation. Factors in the environment that affect the
person are categorized as focal, contextual, and residual
stimuli.
• Regulator – subsystem coping mechanism which
responds automatically through neural-chemical-
endocrine processes.
• Cognator - subsystem coping mechanism
which responds to complex processes of perception
and information processing, judgment, and emotion.
These subsystems are the mechanisms used by human
beings to cope with stimuli from the internal and external
environment.

Rambo 1984
 RESPONSES

Adaptive Responses – responses that promote integrity

of the person in terms of goals of survival, growth,
reproduction, and mastery.
Ineffective Responses – responses that do
not contribute to adaptive goals.
 ADAPTIVE MODES
• Physiological: oxygenation, nutrition
and elimination, activity, rest and
protection.
• Self-Concept: Psychological and spiritual
elements.
• Role Function: Primary, secondary and tertiary
roles the person performs in the society.

• Interdependence: Coping mechanism arising

from close relationships.

• Goal: promote integrated adaptation in all

four modes= Health.
 CONTD…

Each adapti ve mode represents a grouping of

behaviors that promote the individuals
movements towards the general goals (survival,
growth, reproducti on, mastery).
 CONTD…

(1).P. HYSIOLOGICAL MODE

 Physiological wholeness is
achieved by adapti ng to changes
in physiological needs.

 The regulator coping mechanism is

primarily responsible for att aining
and maintaining this integrity.

 The other complex process t h at

influences regulator acti vities are
the senses, fluids and electrolytes,
neurological function & endocrine
function.
F IVE PRIMARY NEEDS HAVE BEEN IDENTIFIED
AS
NECESSARY FOR PHYSIOLOGICAL INTEGRITY :

Oxygen,
Nutriti on,
Acti vity
rest,
Protection,
Eliminati o
n
CONTD…

(2)SELF CONCEPT MODE

Self concept is one of the 3 psychosocial modes, the

basic human need within modes in psychic
integrity,which means people need to know who
they are so that can exist with a sense of unity.
  P HYSICAL SELF : IS AN APPRAISAL OF ONE’S PHYSICAL
ATTRIBUTES , APPEARANCE , FUNCTIONING , SENSATION
( FEELING ABOUT SELF ) WELLNESS SEXUALLY AND
ILLNESS
STATUS .

 Personal self: is an appraisal of one’s own

characteristi cs, expectati ons, values & worth.
Personal self has been divided into the moral
ethical spiritual self ,self consistency & self
ideal, self expectancy e.g. I believe God will
help me through this surgery.
CONTD…..

(3)ROLE FUNCTION MODE:

The basic need in the role function
adapti
model ve is for social integrity. This means t h at
people need to know who they are in relati on to
others so that they can act. All people have role in
society. With each role there are expected
behavior .Role have been divided into primary,
secondary and terti ary.
CONTD….
(4)INTERDEPENDENCEMODE
 Interdependence a social adapti ve
is adequacy or
mode,needs the
affection
feeling of security in nurturing
relati onships.
willingness & ability to love, respect & value
 Interdependence
others and to acceptmeans the to love,
& responds close
relati onship
respect and value of people
given that involves
by others.
 Loneliness a common adaptation
as problem
resulti ng from a disrupti on in
the modes.
 ROY’SMODEL(A SYSTEM MODEL)
• Roy’s model is a system model that focuses on outcomes.

• The major features of the system models are the

system and its environment
• A system is a set of parts connects to function as a
whole for some purposes and are interdependence of
its parts.

• A system is characterized by inputs, outputs, control and

feedback processes.
 1) Input-input coming from external
environment as well as internally from t he person
as a sti muli(a sti mulus is a unit of informati on,
matter, or energy from the wh ole environment or a
person elicits a response) The sti muli immediately
confronting the person are focal sti muli greatest
degree of change impact on person.
CONTD…

Contextual stimuli-observable, measureable

and reported by the person.

Residual sti muli-those make up characteristi cs of

the person that are present and relevant to
situati on.
 CONTD…….

Example: Mr. smith experiencing t he pain,

chest the sti mulus Mr
immediately confronti ng .
smith,the
supply focal
to his sti mulus
heart ,is the contextual
muscles.The deficit of sti
oxygen
muli
include the 90 degree of temperature ,the
sensati on of pain ,Mr. smith’s age ,weight,blood
sugar level,and degree of coronary artery
patency.The residual sti muli include his history of
cigarett e smoking and work relate stress.
Adaptati on level is a constantly changing point that
represents the person’s ability to cope with the
changing environment in a positive manner.

Adaptation level sets up a zone or a

range within which sti mulati on will lead
toadapti ve responses.

Stimuli fallingoutside their adaptive zone

lead to ineffective responses.

Suicide due to inability to cope up

with the child is an extreme example of an
ineffective response.
 C OPING MECHANISMS

some coping mechanisms

are inherited or genetic
 CONTD….
 Mechanisms are of 2 types:

(1)) Reg ul ato r is used as a mechanism to

primarily cope with

( 2physiological sti muli.

) C o g nato r used mainly as mechanism to cope with
psychological sti muli dealing primarily area of
in cognition, judgment and emoti on.
 -Regulator a n d cognator mechanisms linked
are through the process of percepti on.
CONTD….
It is important to recognize t hat it is the
manifestati on of the coping mechanism th at
can be observed and within the
adaptive modes. measured
Thus
often referred as effectors. modes are
adapti ve
 CONTD….
Eff ectors: Roy has identi fi ed four adapti ve
modes;
Physiological

Self concept

role functi on
interdependence.
 CASE STUDY(HYPOTHETICAL)
• Mr.NR who was suffering with diabetes mellitus for past 10 years.
He developed a diabetic foot and and recent
ulcer
amputation made his life more stressful. . He
was
admitted in Hospital. He is conscious and oriented. He is anxious
about the disease condition. Like to go home as early as
possible. Showing signs of stress. Touch and pain sensation
decreased in lower extremity. Thinking and memory is intact. Mr.
NR was selected for application of RAM in providing nursing care.
1. ASSESSMENT OF BEHAVIORS

• Alteration in Physical and Self-concept mode

He is anxious about changes in body image

• Change in Role performance mode

He was the earning member in the family. His
role shift is not compensate.

Matt Vera, 2014

2. ASSESSMENTOF STIMULI

 Focal Stimuli :

Non-healing wound after amputation

of great and second toe of left leg- 4
week
 Contextual stimuli:
Known case DM for past 10 years and on treatment with
insulin for 8 years.
 Residual stimuli:
No special knowledge in health matters
 3. NURSINGDIAGNOSIS

• Anxiety related to hospital admission and

unknown Outcome of the disease and financial
constraints.

Matt Vera,
2014
 4. GOALSETTINGS

Long term Objective:

The client will remain free from anxiety

Short term objective:

i. Demonstrating appropriate range effective coping in the
treatment
ii. Being able to rest and
iii. Asking fewer questions
Matt Vera, 2014
 5. INTERVENTION

Allow and encourage the client and family to ask

questions. Bring up common concerns.
- Allow the client and family to verbalize
anxiety.
-Stress that frequent assessment are routine and do not
necessarily imply a deteriorating condition.
-Repeat information as necessary because of the reduced
attention span of the client and family

Matt Vera, 2014

6. EVALUATION

Short term goal:

Met: demonstrated appropriate range effective coping
with treatment He is able to rest quietly.
Long term goal:
Unmet: client not completely remained
free from
anxiety due to financial constrains- Continue plan
Reassess goal and interventions
Matt Vera, 2014
CONCLUSION

Mr.NR who was suffering with diabetes

mellitus for past 10 years. Diabetic foot ulcer
and recent amputati on made his life more
stressful. Nursing care of this pati ent based
on Roy's adaptati on model provided had a
dramati c change in his condition. He studied
how to use crutches and mobilized at least
twice in a day.
Patient’s anxiety reduced to a great extends
by proper explanati on and reassurance.
He gained knowledge on
various aspectgood
of diabetic foot ulcer for the
future self care activities.
 ROY’SADAPTATION MODEL CONT..

• A total of 163 studies were conducted by the

group of seven scholars to test the
proposition of the model.

• Has been in use for more than 49 years in

providing direction for nursing
practice, education, administration and
research.

• Internationally used.
Alligood M.R Ann
Marriner(2010)
 APPLICATION OF R.A.M IN NURSING
 (1) Nsg practice- R.A.M is a very useful method in
nursing practi ce specially in those setti ng where there
are convert psychological needs which are as essenti al as
physical one. Roy’s models are very effective in pediatrics
as well as community and rehabilatory nsg.
( 2)Nursing Research-
R.A.M provide a conceptual model for nursing
process and this has been a basis for number
of research being done.for e.g measuring
functional status after child birth,functional
status during pregnancy.

Roy has stated that theory development and

the testing of developed theories are
nursing’s highest priorities. The model must
be able to regenerate testable hypotheses
for it to be researchable.
( 3)
Education-
RAM useful in educational setti ng. Roy states that the model
defines for students the distinct purpose of nursing which is to
promote man’s adaptati on in each of the adapti ve modes in
situati ons of health and illness.