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

2. 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.

3. 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

4. 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.

5. 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.

6. 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).

7. 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.

8. 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

9. 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

10. 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

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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 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 ). Philadelphia, PA: F.A. Davis Company.
Roy's Adaptation Model. (2013, September 9). Retrieved October 14, 2014, from