1. Adaptation model theory  Sister calister Roy

2. 1939-present  Presenters الترابي السيد موسي ادم محمد عبدا لحليم دلال ابراهيم اسامه عوض الكريم Sister calister Roy Adaptation model theory

3. Introduction: -historical background Major concepts Major assumptions Nursing practice Analysis and critique

4.  Sr.Callista Roy, a prominent nurse theorist, writer, lecturer, researcher and teacher Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College, Los Angeles in 1963. a master's degree program in pediatric nursing at the University of California,Los Angeles in 1966.

5.  She also earned a master’s and PhD in Sociology in 1973 and 1977,respectively.  Sr. Callista had the significant opportunity of working with Dorothy E. Johnson  Johnson's work with focusing knowledge for the discipline of nursing convinced Sr. Callista of the importance of describing the nature of nursing as a service to society and prompted her to begin developing her model with the goal of nursing being to promote adaptation.  She joined the faculty of Mount St. Mary's College in 1966, teaching both pediatric and maternity nursing.

6.  Influencing Factors She organized course content according to a view of person and family as adaptive systems.  She introduced her ideas about ‘Adaptation Nursing’ as the basis for an integrated nursing curriculum.  Goal of nursing to direct nursing education, practice and research  Model as a basis of curriculum impetus for growth--Mount St. Mary’s College  1970-The model was implemented in Mount St. Mary’s school  1971- she was made chair of the nursing department at the college.

7.  Roy developed the basic concepts of the model while she was graduate student at the university of California at 1964to1966.  Began oprationalizating her model in 1968 when mount saint marys college.  Roy adaptation model was first presented in the literature in an article published in nursing outlook in 1970.  Roy has published many books chapters and periodical articles.  Roy has been recognized in the world who’s who of women 1979 personalities of America 1978.

8.  Theoretical sources :-  Derivation of the Roy adaptation model for nursing included citation of harry helsons work in psychophysics that extended to social and behavioral sciences[roy1984].

9.  According of helsons theory :-  Adaptation:-is process of responding positively to environment changes [Roy and robert1981] combined helsons work with raports definition of system to view the person to adaptive system.  After the development of her model Roy presented it as a frame work for nursing practice,research and education.  More than [1500] faculty and students have contributed to the theoretical development of the adaptation model by [1987] it was estimated that over 100,000nures in u.s and Canada had been prepared to practice using the Roy model.

10.  In introduction to nursing and adaptive model Roy [1976] discussed self concept and group identity mode.  Social interaction theories are cited to provide theoretical basis.  Roy suggestion that self arises from social inter action (Roy 1984).  Additional development of the model occurred during the later 1900 into the twenty first century. These developments included update scientific and philosophical assumptions a redefinition of adaptation levels ;extension of the adaptive modes to group level knowledge development;

11.  System :  a set of parts connected to function as a whole for some purpose and that dose so by virtue of the interdependence of its parts  Systems also have input,output, control and feedback processes

12.  Adaptation level:  Adaptation level represents the condition of life processes described on three level as integrated, compensatory and compromised its a changing point made up of  A. Focal stimuli  B. Contextual stimuli  C.residual stimuli

13.  Adaptation problems  These describe the difficulties related to the indicators of positive adaptation

14.  Focal stimuli  Which immediately confront the individual  Contextual stimuli  Which are all other stimuli present that contribute to the effect of the focal stimuli  Residual stimuli  Environmental factors within or without the human system

15.  Coping Process:  innate or acquired ways innate or of interacting with the changing of environment  Innate coping mechanism:  Are genetically determined to the species and are generally viewed as automatic processes  Acquired coping mechanisms:  Developed throughout strategies such as learning

16.  Regulator subsystem:  Regulator is a major coping processes involving the neural, chemical and endocrine systems  Cognator subsystem:  Is major coping processes involving four cognitive emotive cannels: perceptual,information processing,learning,judgment and emotion

17.  Adaptive Responses:  responses that promotes integrity in terms of the goals of the human system  Ineffective Responses:  responses that do not contribute to integrity in terms of the goals of the human system  Integrated life process:  It’s the structures and functions of a life process are working as a whole to meet human needs

18.  Physiological  Self-concept  Role function  Interdependence

19.  Physiologic-Physical Mode: Behavior pertaining to the physical aspect of the human system Physical and chemical processes Nurse must be knowledgeable about normal processes in the function and actives of the living organisms 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection

20.  Self Concept-Group Identity Mode:  The composite of beliefs and feelings held about oneself at a given time. Focus on the psychological and spiritual aspects of the human system and purposefulness of 2 modes (physical self, and personal self)

21.  Role function Mode:  Set of expectations about how a person occupying one position behaves toward a occupying another position. Basic need-social integrity, the need to know who one is in relation to others  Interdependence Mode:  Behavior pertaining to interdependent relationships of individuals and groups. Focus on the close relationships of people and their purpose. Involves the willingness and ability to give to others and accept from others.

22.  Perception:  It’s the interpretation of a stimulus and the conscious appreciation of it

23. According to Roy, adaptation refers to ‘the process and outcome whereby thinking and feeling persons as individuals or in groups,. Rather than system simple striving to respond to environmental stimuli to maintain integrity, every human life is purposeful in universe that is creative and person are inseparable form their environment. major assumptions adaptation :

24.  Roy defines nursing broadly as a 'health care profession that focuses on human life process's and patterns and emphasizes promotion of health for individuals, families, groups, and society as whole’’.  Specifically,Roy defines nursing according to her model as the science and practice.  Nursing judgment are based on the assessment and intervention are planned to mange the stimuli (Roy& andreews,1999) Roy differentiates nursing as science from nursing as a practice discipline.

25.  Nursing science is "developing system of knowledge about persons.  Nursing as a practice discipline in ”nursing scientific body of knowledge used for the purpose of providing an essential service to people that is promoting ability to affect health positively.  Roy,s goal of nursing is “the promotion of adaptation for individuals and groups.

26.  According to Roy,the human system is described as a whole with parts that function as unity for some purpose.  Human system include people as individual or in group.  Defined the person as the main focus of the nursing the recipient of nursing care a living,complex adaptive system with internal processes (contort and regulator) acting to maintain adaptation in the four adaptive modes (physiological, self-concept, role function,and interdependence).

27.  Nursing science is "developing system of knowledge about persons.  Nursing as a practice discipline in ”nursing scientific body of knowledge used for the purpose of providing an essential service to people that is promoting ability to affect health positively.  Roy,s goal of nursing is “the promotion of adaptation for individuals and groups.

28.  Health is a state and a process of begin and becoming integrated and whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment. In her earlier work Roy viewed health a long – a continuum following from death and extreme poor health to high level and peak wellness. During the late 1990s, Roy’s writings focus more on health as a process in which health and illness can coexist. Roy wrote (health health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to cope with them incompetent way )

29.  According to Roy environment is all the condition, circumstances, and influences as surrounding and effecting the development and behavior of person or groups, with particular consideration of the mutuality of person and earth resources that includes focal, contextual, and residual stimuli. It is the changing environment (that) stimulates the person to make adaptive responses. Environment is the input into the person as an adaptive system involving both internal and external factor, change demands increasing energy to adapt to the situation. Factors in the environment that effect the person are categorized as the focal, contextual and residual stimuli.

30.  Theoretical assertions

31. Stimuli Adaptation Level  Focal  Contextual  Residual

32.  Coping Mechanisms  Regulator Major Coping Process Involving Neural, Chemical,And Endocrine  Cognator Major coping process involving four cognitive emotive channel; perceptual and information processing, learning,judgment and emotion

33.  Physiological Function Oxygenation,Nutrition,Elimination,Activity and rest,and Protection Senses ; fluid, electrolyte,and Acid base balance; neurological function; and endocrine function  Self-concept Physical Self which involves sensation and body image Personal Self which is made up of self- consistency, Self ideal or expectancy and the moral- ethical- spiritual self  Role Function Primary role Secondary role Tertiary role

34.  Interdependence tow specific relationships The first is with significant others, persons who are the most important to the individual The second is with support systems that is contributing to meeting interdependence needs  Major areas Of interdependence behaviors have been identified receptive behavior and contributive behavior

35.  Adaptive  Ineffective responses Feedback

36. promote adaptation. Sister Callista Roy (1984), Introduction to Nursing: An Adaptation Model

37.  ACCEPTANCE OF NURSING COMMUNITY TO ROYS MODEL SHOWED IN  PRACTICE  EDUCATION  RESEARCH

38.  The Roy adaptation model is deeply rooted in nursing practice it.  remains one of most frequently used conceptual frameworks to guide nursing practice.  Roy’s model is useful for nursing practice because it outlines the features of the discipline and provides direction for practice. The model consider goals values, the patient and practitioner interventions

39.  It is a valuable theory for nursing practice because it includes a goal that specified as aim for activities to realize the goal.  The interventions are the management of stimuli by removing, increasing, decreasing or altering them. These interventions can be obtained by listing practice-related hypotheses generated by the model.

40.  With use of Roy's six step nursing process, the nurse performs the following six functions ;  1-assesses the behaviors manifested from the four adaptive model.  2- assesses the stimuli for those behaviors and categorized them as focal, contextual or residual stimuli.  3- make statement or nursing diagnosis of the person’s adaptive state.  4- set goals to promote adaptation  5-implements interventions aimed at managing the stimuli to promote adaptation  6- evaluates whether the adaptive goals have been met.  By manipulating the stimuli and not the patient the nurse enhance the interaction of the person with their environment thereby promoting health.

41.  Roy and colleagues have developed a typology of nursing diagnosis from perspective of Roy’s adaptation model.  Senesac(2003): reported that the Roy’s adaptation model has been used to the greatest extent by individual nurse to understand, plan, and direct nursing practice in the care of individual patients.

42.  Villareal(2003) : applied the Roy adaptation model to the care of young women who were contemplating smoking cessation.  Samarel (2002) ; examined the effect of tow types of social support and education on adaptation to early stage breast cancer. Newman (1997) ; applied the Roy adaptation model to caregivers of chronically ill family members.

43.  The model distinguishes nursing science from medical science by having the content of these areas taught in separate courses.  She stresses collaboration but delineates separate goals for nursing and physicians.  Roy (1979) ; suggests that the model clarifies objectives, identifies content and specifies patterns for teaching and learning.  The Roy adaptation model provides educators with a systemic way of teaching students to assess and care for patients within the context of their lives rather than just as victims of illness.

44.  Roy adaptation model has been used extensively to guide knowledge development through nursing research.  Young-McCaughan (2003) ; studied the effect of a structured aerobic exercise tolerance, sleep patterns and quality of life in patients with cancer from the perspective of the Roy adaptation model.  Zhan (2000) ; found that cognitive adaptation plays an important role in helpingolder adult maintain self consistency in the face of hearing loss.  Bournaki(1997); studied pain-related responses to venipuncture in school-age children from perspective of Roy adaptation model.

45.  CLARITY ;  Duld and Giffin stated that the Roy’s arrangement of concepts is logical, but that the development of definitions is inadequate related to her original format.  Terms and concept borrowed from other disciplines are not redefined for nursing.

46.  This model has several major concepts and subconcepts, there for, it has numerous relational statements and is complex.

47.  Roy defines her model as drawn from multiple middle range theories and advocates multiple middle range theories for use in nursing.  Generalizable to all settings in nursing practice, but is limited in scope because it primarily addresses the concept of person- environment adaptation and focuses primarily on the patient. Information on the nurse is implied.