The Roy Adaptation Model of Nursing Presented by: Merlessa Rosacina, RN, BSN Nursing Concepts & Theories The University of Texas Medical Branch

Sister Callista Roy Born October 14th, 1939 in Los Angeles, California Joined as a Sister of St. Joseph of Cardonelet – member for 50 years Education: BSN – Mt. Saint Mary’s College in LA, 1963 MSN – University of California LA, 1966 Master’s in Sociology – University of California LA, 1973 Doctor in Sociology – University of California in LA, 1977 Postdoctoral Studies in Neuroscience Nursing – University of California at San Francisco Currently serves as a faculty member and nurse-theorist at Boston College. Honored as a Living Legend by the American Academy of Nursing and the Massachusetts Association of Registered Nurses.

Historical Development Adaptation model developed while Roy was still a master’s nursing student at UCLA Mentored by Dorothy E. Johnson, another nurse theorist (Stephanie is presenting on her) 1970 – 1st publication of model appeared while a faculty member at a small liberal arts college Lead implementation Used it as a part of the curriculum 1500 faculty & students helped refine the model over the next decade at Mount St. Mary’s college 1981 – Conference held at Mount St. Mary’s acknowledge the model’s significance, usefulness, and completeness 1987 – more than 100,000 students graduated from curricula based on the Roy model

Assumptions of RAM Philosophic Scientific Cultural People have mutual relationships with the world and God, people use human creative abilities of awareness, enlightenment, and faith. Self and environmental awareness is rooted in thinking and feeling, system relationships include acceptance, protection, and fostering interdependence. Cultural expression may lead to changes nursing practices like nursing assessments, cultural experiences influence how Roy’s Model is expressed Implicit Assumptions People are a bio-psycho-social beings Person uses innate and acquired mechanisms (biological, psychological, and social) to cope with a changing world. Person must adapt in order to respond positively to environment. Four models of adaptation: physiologic needs, self-concept, role function, and interdependence Explicit Assumptions Person can be reduced to parts for study and care. Nursing is based on causality. Values and opinions should be considered and respected. Adaptation frees energy that can be used to respond to other stimuli.

Theory Development Roy began her theoretical work by constructing the concept of the goal of nursing Wanted to ID the function of nursing that promotes health Influence as a pediatric staff nurse Noted the great resiliency of children responding to major physiologic and psychological changes Nursing intervention was needed to promote positive coping Adaptation / Positive Coping  the goal or function of nursing Goal of nursing: The promotion of adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health, quality of life, and dying with dignity. The RAM is a conceptual deductive theory, based on causality.

Model Concepts: People as Adaptive Systems People, individually and in groups, are holistic adaptive systems, complete with coping processes acting to maintain adaptation and to promote person and environment as transformations. Individuals Regulator subsystem – uses physiologic process such as chemical, neurologic, and endocrine response to cope with the changing environment Cognator subsystem – involves the cognitive and emotional process that interact with the environment Example: A person sees an oncoming car after stepping off a curb. The person’s body pumps adrenaline that provides energy to move out of the way (regulator), while the emotion of fear is experienced helping him/her escape (cognator).

Model Concepts: People as Adaptive Systems Groups Stabilizer subsystem – structures, values, and daily activities work together to accomplish the primary purpose of the group Example: The Family’s purpose is to earn a living ad provide nurturance and education for the children. Family values influence how members respond to its environment in order to fulfill responsibilities to maintain the family. Innovator subsystem – response to environmental change Example: Organizations plan activities and team building sessions. During this time, the group creates new goals and growth resulting in progression.

Model Concepts: People as Adaptive Systems Four adaptive modes: Physiologic-physical: people as individuals interact as physical beings with environment Senses; fluid, electrolyte, acid-base balance; neurologic function; endocrine function Self-concept: composite of beliefs and feelings that a person holds about him or herself at a given time; sense of purpose Involves developing self, perceiving self, and focusing self Role function: roles on people in society filling their needs for social integrity, relating self to others Individual needs to know who one is in relation to others to act Interdependence modes: close relationships of people and their purpose, structure and  development

Model Concepts: Environment Roy defines environment as all the conditions, circumstances, and influences surrounding and affecting the development and behavior or individuals and groups. Three categorized factors of environmental stimuli Focal – factors immediately affecting the person Contextual – all other stimuli affecting situation Residual – factors whose effect are unclear Three levels of adaptation Integrated adaptation – structures and functions of the adaptive modes are working together and meets human needs Compensatory adaptation – occurs when the cognator and regulator or stabilizer and innovator are activated by a challenge Compromised adaptation – occurs when integrated and compensatory processes are inadequate, creating an adaptation problem

Model Concepts: Health Roy defines health as the reflection of personal and environmental interactions that are adaptive. A process A state of being Becoming whole and integrated in a way that reflects individual and environment mutuality

Practice Applications Adaptation is a significant life process that leads to health. 5 step process for developing middle or practice level theory and nursing knowledge: Select a life process. Study the life process in literature and in people. Develop an intervention strategy to enhance the life process. Derive a proposition for practice. Test the proposition in research.

Nursing Process in Relation to RAM 1st level assessment gather data about certain behavior of the person or group. 2nd level assessment identifies internal and external stimuli that influences behavior. 1st & 2nd level assessments create a nursing diagnosis. Data is interpreted and classified into an adaptation level of integrated, compensatory, or compromised. The nurse collaborates with the person or group to set goals or behavioral outcomes. Interventions are based on the best way to assist the person in reaching the goal. Evaluation judges the effectiveness of intervention. Although steps are sequential, this is an ongoing process and steps can occur simultaneously.

RAM in Practice Senesac (2003) Reviewed published projects using the Roy Adaptation Model in institutional practice settings. 7 distinct projects – ranges from ideologies to hospital wide Findings Some projects developed from unit implementation to full agency implementation like Gray (1991) – 132 bed acute care, non profit pediatric hospital Some incomplete d/t changes in management, philosophy or direction Many US hospitals reference RAM when working towards Magnet Status Certification Focus: Improve patient care through quality nursing care plans and improve quality nursing care.

Limitations Time limitations Scope limitations Generalized to all nursing practice Time required for comprehensive assessment of psychosocial behaviors is difficult for rapid-paced settings (ER) Scope limitations Generalizable to all settings in nursing practice, but focuses on person- environment adaptation.

Questions Have you seen Roy’s Adaptation Model in a real life application? Were the outcomes favorable? Do you have a suggested solution to Roy’s time limitation? Use the 5 Step process described by Roy in your own research study.

References Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (2nd ed., p. 293). Philadelphia: F.A. Davis. Gall, E. (2013, March 16). Roy Adaptation Model: Theory Analysis. Retrieved October 14, 2014, from http://nursingtheoryandtheoristsroyorem.weebly.com/1/post/2013/03/r oy-adaptation-model-theory-analysis.html Parker, M., & Smith, M. (2010). Sister Callista Roy's Adaptation Model. In Nursing theories & nursing practice (3rd ed., pp. 167-175). Philadelphia, PA: F.A. Davis Company. Roy's Adaptation Model. (2013, September 9). Retrieved October 14, 2014, from http://currentnursing.com/nursing_theory/Roy_adaptation_model.html