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nes & Bartlett Learning, LLC FOR SALE OR DISTRIBUTION

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onal Association of Long Term Care Administrator Boards

10


© Jones & Bartlett Learnin NOT FOR SALE OR DISTR

ROY ADAPTATION National Association of Long Term Care Administrator Boards MODEL: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR Sister SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Callista Roy National Association of Long Term Care Administrator Boards

nes & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC L e a r n i ng O b je c t i v e s NOT FOR SALE OR DISTRIBUTION FOR SALE OR DISTRIBUTION

onal Association ofAfter Long Term this Care Administrator Boards completing chapter the student should be able to 1. Describe the concepts of the Roy adaptation model as proposed by ©Roy Jones & Bartlett Learning, LLC

NOT FOR SALE OR DISTRIBUTION

2. Explain the major concepts important to nursing as defined by Roy


National Association of Long Term Care Administrator Boards

3. Plan nursing care for a patient scenario utilizing the Roy adaptation model



K e y T e r mof s Long Term Care Administrator Boards National Association Adaptation

nes & Bartlett Learning, LLC Adaptive modes FOR SALE OR DISTRIBUTION

Cognator subsystem

© Jones & Bartlett Regulator subsystem

Learning, LLC NOT FOR SALE OR DISTRIBUTION

onal Association of Long Term Care Administrator Boards © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION


National Association of Long Term Care Administrator Boards © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION



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nes & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

72376_TEXT_Masters.indd 127 onal Association of Long Term Care Administrator Boards

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onal Association of Long Term Care Administrator Boards 128

N ursing T heories : A F ramework for P rofessional P ractice



S

ister C allista R oy was born in 1939 in

Los Angeles, California. She received aBoards baccaNational Association of Long Term Care Administrator

laureate degree in nursing in 1963 from Mount Saint Mary’s College. In addition to earning a mas© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ter’s degree in nursing in 1966 from the University of BACKGROUND NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION California–Los Angeles, Roy earned a master’s degree sociology in 1973, followed by a doctorate in sociNational Association of Long TerminCare Administrator Boards ology in 1977, both from the University of California (Phillips, 2010, p. 335). nes & Bartlett Learning, LLC © Jones & the Bartlett Learning, LLC Roy developed basic concepts of her model FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION while she was a graduate student at the University of California–Los Angeles begin challenged by Dorothy Johnson in a seminar to onal Association of Long Term Careafter Administrator Boards develop a conceptual model for nursing. The Roy adaptation model was first published in 1970. Since that time, Roy has published many books © Jonesand & articles, Bartlett LLC & Bartlett Learnin andLearning, has presented numerous lectures focusing© onJones the model NOT FOR NOT FOR SALE OR DISTRIBUTION and its use in nursing practice. She has also continued to refine and rede-SALE OR DISTR the model (Roy, 2009; Roy & Andrews, 1991, 1999) and has been Nationalfine Association of Long Term Care Administrator Boards awarded many honors for her contributions to nursing theory, practice, research, and education (Phillips, 2010). © Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC Roy credits Harry Helson’s adaptation© theory for playing a key role in NOT FOR SALE OR DISTRIBUTION NOT OR DISTRIBUTION her early thinking and development of her ownFOR model.SALE She also credits Rapoport’s definition of systems as well as concepts from Lazarus and National Association of Long Term Care Administrator Boards Selye (Roy & Roberts, 1981). In addition, Roy acknowledges the contributions made by other faculty and students to the development of the model is of the mostLLC widely nes & Bartlett Learning, LLCmodel. The Roy adaptation © Jones & currently Bartlettone Learning, used frameworks in nursing practice, applied hundreds of thouFOR SALE OR DISTRIBUTION NOT FOR being SALE OR by DISTRIBUTION sands of nurse in countries all over the world.


T

he R oy adaptation model presents the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learnin OVERVIEW person as a holistic adaptive system in constant NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION OF THE Roy interaction with the internal and the external National Associationenvironment. of Long Term Care Boards The main taskAdministrator of the human system is to ADAPTATION maintain integrity in the face of environmental stimuli MODEL

(Phillips, 2010). The goal of nursing is to foster suc-

© Jones & Bartlett Learning, LLC cessful adaptation. NOT FOR SALE OR DISTRIBUTION





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According to Roy and Andrews (1999), adaptation refers to “the proThe adaptation cess and outcome Association whereby thinkingofand feeling persons as individuals National Long Term Care Administrator Boards level represents or in groups, use conscious awareness and choice to create human and the condition of environmental integration” (p. 54). Adaptation leads to optimal health the life processes. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and well-being, to quality of life, and to death with dignity (Andrews & Three levels are NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Roy, 1991). The adaptation level represents the condition of the life pro- described by Three levels described by Roy: compensatory, and Roy: integrated, Nationalcesses. Association ofareLong Term Careintegrated, Administrator Boards compromised life processes. An integrated life process may change to a compensatory, and compromised life compensatory process, which attempts to reestablish adaptation. If the processes. nes & Bartlett Learning, LLC Jones & Bartlett LLC compensatory processes are not adequate,©compromised processes Learning, result FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (Roy, 2009, p. 33). in the Administrator Roy adaptation model include both innate coponal Association of Coping Longprocesses Term Care Boards ing mechanisms and acquired coping mechanisms. Innate coping processes are genetically determined or common to the species; they are generally & processes. BartlettInLearning, LLC coping processes are © Jones & Bartlett Learnin viewed©asJones automatic contrast, acquired NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION learned or developed through customary responses (Roy, 2009, p. 41). The processes for coping in the Roy adaptation model are further National Association of Long Term Care Administrator Boards categorized as “the regulator and cognator subsystems as they apply to individuals, and the stabilizer and innovator subsystems as applied to © Jonesgroups” & Bartlett Learning, © Jones & Bartlett Learning, LLC (p. 33). A basic typeLLC of adaptive process, the regulator subsysNOT FOR OR DISTRIBUTION NOTchannels. FOR SALE OR DISTRIBUTION temSALE responds through neural, chemical, and endocrine coping Stimuli from the internal and external environment act as inputs through National Association of Long Term Care Administrator Boards the senses to the nervous system, thereby affecting the fluid, electrolyte, and acid–base balance, as well as the endocrine system. This information is all channeled producing an automatic, nes & Bartlett Learning, LLCautomatically, with the ©body Jones & Bartlett Learning, LLC unconscious response to it (p. 41). FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The second adaptive process, the cognator subsystem, responds onal Associationthrough of Long Care Administrator Boardsand information fourTerm cognitive–emotional channels: perceptual processing, learning, judgment, and emotion. Perceptual and information processing includes&activities selective attention, © Jones BartlettofLearning, LLC coding, and mem- © Jones & Bartlett Learnin ory. Learning involves imitation, reinforcement, and insight. Judgment NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION includes problem solving and decision making. Defenses are used to seek National Association ofappraisal Long Term Care Administrator Boards relief from anxiety and make affective and attachments through the emotions (p. 41). The cognator–regulator and stabilizer–innovator subsystems func© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tion to maintain integrated life processes. These life processes—whether






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integrated, compensatory, or compromised—are manifested in behaviors the individual orof group. Behavior viewedAdministrator as an output of theBoards human NationalofAssociation Long Termis Care system and takes the form of either adaptive responses or ineffective responses. These responses serve as feedback to the system, with the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC human system using this information to decide whether to increase or NOT FOR SALE OR decrease DISTRIBUTION NOT FOR SALE OR DISTRIBUTION its efforts to cope with the stimuli (Roy, 2009, p. 34). one can identify specific processes inherent in the regulaNational Association ofAlthough Long Term Care Administrator Boards tor–cognator subsystems, it is not possible to directly observe the functioning of these systems. The behaviors can be observed in four categories, or nes & Bartlett Learning, LLCadaptive modes: physiologic–physical © Jones & mode, Bartlett Learning, LLC self-concept–group identify FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION mode, role function mode, and interdependence mode. It is through these fourCare modesAdministrator that responses to Boards and interaction with the environment can onal Association of Long Term be carried out and adaptation can be observed (p. 43). Behavior in the physiologic–physical mode is the manifestation of © Jonesthe&physiologic Bartlett activities Learning, © Jones & Bartlett Learnin of allLLC cells, tissues, organs, and systems making NOT FOR NOT FOR SALE OR DISTRIBUTION up the body. Five basic needs exist: oxygenation, nutrition, elimination,SALE OR DISTR and rest, and protection. In addition, four processes are involved Nationalactivity Association of Long Term Care Administrator Boards in physiologic adaptation: the senses; fluid, electrolyte, and acid–base balance; neurologic function; and endocrine function. The underlying need © Jones & Bartlett Learning, LLC mode is physiologic integrity © Jones & Bartlett Learning, LLC for the physiologic (p. 43). When viewing NOT FOR SALE OR DISTRIBUTION FOR itSALE OR DISTRIBUTION the first mode in relationship to a group ofNOT individuals, is appropriate to use the terminology “physical mode” and to look at the group manifestaNational Association of Long Term Care Administrator Boards tion of adaptation in terms of basic operating resources, because the basic need associated with the physical mode for a group is resource adequacy in physical resource needs nes & Bartlett Learning, LLCor wholeness achieved by©adapting Jonesto&changes Bartlett Learning, LLC (Roy, 2009, p. 43–44). NOT FOR SALE OR DISTRIBUTION FOR SALE OR DISTRIBUTION The self-concept–group identity mode includes the components of the onal Association of Long Term Care Administrator Boardsand body image, and the personal physical self, including body sensation self, including self-consistency, self-ideal, and moral–ethical–spiritual basic need underlying the self-concept mode for the individual © Jonesself. & The Bartlett Learning, LLC © Jones & Bartlett Learnin is psychic and spiritual integrity—that is, the need to know who one is NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION so that one can be or exist with a sense of unity (p. 44). “Group identity” National Long Term Care Administrator is Association the term used toof refer to the second mode with groups. ThisBoards mode comprises interpersonal relationships, group self-image, social milieu,






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culture, and shared responsibility of the group. Identity integrity is the need underlying group adaptiveof mode (p. 44). Nationalthis Association Long Term Care Administrator Boards The role function mode focuses on the roles of the person in society and the roles within a group. The basic need underlying the role function © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC mode is social integrity—that is, the need to know who one is in relation NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION to others so that one will know how to act (p. 44). Finally, the interdependence modeCare is a category of behavior related to National Association of Long Term Administrator Boards interdependent relationships. This mode focuses on interactions related to the giving and receiving of love, respect, and value. The basic need nes & Bartlett Learning, Jones & Bartlett Learning, LLC of this modeLLC is relational integrity, or the© feeling of security in nurturing FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION relationships. Thus it follows that two specific relationships are the focus this mode the individual: significantBoards others and support sysonal Associationwithin of Long TermforCare Administrator tems. For the group, the interdependence mode relates to the social context in which the group operates; important factors in this case include © Jones & Bartlett Learning, LLC © Jones & Bartlett Learnin infrastructure and member capability (Roy, 2009, p. 45). NOT FOR SALE OR DISTRIBUTION In the Roy adaptation model, three classes of stimuli form the envi- NOT FOR SALE OR DISTR ronment: the focal stimulus, contextual stimuli, and residual stimuli.


❖❖ “The focal stimulus is the internal or external stimulus most immediately in the awareness of the individual or group— the Bartlett LLC in the consciousness” © object orLearning, event most present (p.Jones 35).

© Jones & NOT FOR SALE OR DISTRIBUTION

& Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION

❖❖ “Contextual stimuli are all other stimuli present in the situation National Association of Long Term Care Administrator that contribute to the effect of the focal stimulus. That is, Boards contextual stimuli are all the environmental factors that present to the human adaptive system from within or outside but which are nes & Bartlett Learning, LLC © Jones Bartlett Learning, LLC not the center of attention or energy” (p. 35). & Even though the FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION contextual stimuli are not the center of attention, these factors do influence how people deal with the focal stimulus. onal Association of Long Term Care Administrator Boards

❖❖ Residual stimuli are environmental factors within or outside human systems, the effects of which are unclear in the situation. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learnin The effects of these stimuli may be unclear if there is no awareNOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION ness on the part of the patient that a stimulus is an influence, or it may not be clear to the observer that these stimuli areAdministrator having National Association of Long Term Care Boards an influence on the human system (p. 36).






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I

n addition to the concepts already pre-

sented, Term the fourCare metaparadigm concepts of nursNational Association of Long Administrator Boards

MAJOR ing are identified in the Roy adaptation model. CONCEPTS These concepts are summarized in Table 10-1. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC OF NURSING NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Person ACCORDING TO National Association of Long TermAccording Care Administrator Boards to the Roy adaptation model, humans are Roy

holistic, adaptive systems. “The human system is described as a whole with partsLearning, that functionLLC as unity nes & Bartlett Learning, LLC © Jones & Bartlett for some purpose. Human systems as individuals, or in FOR SALE OR DISTRIBUTION NOT FORinclude SALEpeople OR DISTRIBUTION groups, including families, organizations, communities, and society as a onal Association of Long Term Care Administrator Boards whole” (Roy & Andrews, 1999, p. 31). The person is the main focus of nursing and is the recipient of nursing care. The person is specifically defined adaptive Learning, system with cognator acting to © Jonesas&“an Bartlett LLC and regulator subsystems © Jones & Bartlett Learnin maintain adaptation in the four adaptive modes” (Roy, 2009, p. 12). NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION


Environment

Environment is the second major concept of the model. It is understood

© Jones & Bartlett Learning, © adaptive Jones systems & Bartlett LLC as the worldLLC within and around humans as (Roy, Learning, 2009, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION p. 46). The environment refers to “all conditions, circumstances, and National Association of Long Term Care Administrator Boards

ӗӗTABLE 10-1 Metaparadigm Concepts as Defined in the Roy Adaptation Model

nes & Bartlett Person Learning, LLC“An adaptive system with cognator © Jones & Bartlett Learning, LLC and regulator subsystems acting to FOR SALE OR DISTRIBUTION FOR modes” SALE(Roy, OR2009, DISTRIBUTION maintain adaptation in theNOT four adaptive p. 12)

onal Association of Long Term Care Administrator Environment “All conditions, circumstances, andBoards influences surrounding and affecting the development and behavior of persons and groups, with particular consideration of mutuality of person and earth resources” (Roy, 2009, p. 12)

Health

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learnin “A state and process of being and becoming an integrated and whole that NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION reflects person and environment mutuality” (Roy, 2009, p. 12)

Care Administrator Nursing National TheAssociation goal of nursing is of “to Long promoteTerm adaptation for individuals and groupsBoards in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behavior and factors©that influence abilities Learning, LLC Jones & adaptive Bartlett Learning, and to enhance environmental factors” (Roy, 2009, p. 12)

© Jones & Bartlett NOT FOR SALE OR DISTRIBUTION

LLC NOT FOR SALE OR DISTRIBUTION




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influences surrounding and affecting the development and behavior of persons and groups, with particular consideration mutuality of person and National Association of LongofTerm Care Administrator Boards earth resources” (p. 12). It is the changing environment that stimulates the person to make adaptive responses (Andrews & Roy, 1991, p. 18). However, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC any environmental change—even if positive—demands increasing energy to NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION adapt to the situation. Factors in the environment that affect the person are as focal,ofcontextual, and residual (Phillips, 2010,Boards p. 343). Nationalcategorized Association Long Term Carestimuli Administrator

Health LLC nes & Bartlett Learning, © Jones & Bartlett Learning, LLC Health is “a state and process of being andNOT becoming integrated FOR SALE OR DISTRIBUTION FOR SALEand ORwhole DISTRIBUTION that reflects person and environment mutuality” (Roy, 2009, p. 12). In her

onal Associationearly of Long Term Careabout Administrator Boards writings, Roy wrote health as existing along a continuum; she

now views this conceptualization of health as “simplistic and unrealistic since it©does not accommodate the coexistence of wellness and illness © Jones & Bartlett Learnin Jones & Bartlett Learning, LLC and excludes individuals with chronic disabilities or terminal illness who, NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION in spite of their condition, are dealing effectively with life’s challenges” The goal of National Longbegan Term CareonAdministrator is (p. 46–47). During Association the 1990s, Roy’s of writings to focus health as nursingBoards “to promote a process in which health and illness can coexist (Roy & Andrews, 1999; adaptation for 2010, p. 342). In either conceptualization, health is viewed as a JonesPhillips, & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC individuals and reflection of adaptation (Andrews & Roy, 1991, p. 21). groups in the four

© NOT FOR SALE OR DISTRIBUTION


adaptive modes, thus contributing to health, quality Roy defines nursing as a “health care profession that focuses on human of life, and dying with dignity life processes and patterns of people with a©commitment promote health nes & Bartlett Learning, LLC Jones & toBartlett Learning, LLC by assessing behavior and full life-potential for individuals, families, groups, and the global sociFOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and factors ety” (Roy, 2009, p. 3). She defines nursing as the science and practice. The that influence onal Association of Long Term Care Administrator Boards goal of nursing is “to promote adaptation for individuals and groups in adaptive abilities the four adaptive modes, thus contributing to health, quality of life, and and to enhance dying with dignity & by Bartlett assessing behavior and factors © Jones Learning, LLC that influence adap- environmental © Jones & Bartlett Learnin factors.” tive abilities and to enhance environmental factors” (Roy, 2009, p. 12). NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION


Nursing


Analysis of the Roy Adaptation Model

The analysis presented here consists of an examination of assumptions and

© Jonespropositions & BartlettasLearning, © Jones & Bartlett Learning, LLC well as a briefLLC critique of the adaptation model of nursing. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION National Association of Long Term Care Administrator Boards



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Assumptions of the Roy Adaptation Model


NationalAssumptions Association of Long Administrator Boards included in Roy’sTerm model Care are classified into three categories: philosophic assumptions, scientific assumptions, and cultural assumptions. Philosophic include the Learning, LLC assumptions of the model © Jones & following: Bartlett Learning,

© Jones & Bartlett LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ❖❖ Persons have a mutual relationship with the world and a God-figure.



❖❖ Human meaning is rooted in an omega point convergence of the universe.

© Jones & Bartlett Learning, LLC

❖❖ God is intimately revealed in the diversity of creation and is the NOT FOR SALE OR DISTRIBUTION common destiny of creation.

onal Association of Long Term Care Administrator Boards ❖❖ Persons use human creative abilities of awareness, enlightenment, and faith.

❖ Persons are accountable for entering the process of deriving, sus-& Bartlett Learnin © Jones & ❖Bartlett Learning, LLC © Jones taining, transforming the universe (Roy, 2009, p.NOT 31). FOR SALE OR DISTR NOT FOR SALE ORand DISTRIBUTION Scientific assumptions of the model include the following: Boards National Association of Long Term Care Administrator ❖❖ Systems of matter and energy progress to higher levels of complex self-organization.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ❖❖ Consciousness and meaning are constitutive of person enviNOT FOR SALE OR DISTRIBUTION NOT FOR SALEand OR DISTRIBUTION ronment integration.


❖❖ Awareness of self and environment is rooted in thinking and feeling.


❖❖ Human decisions© areJones accountable for integration of creative & Bartlett Learning, LLC processes. NOT FOR SALE OR DISTRIBUTION

❖❖ Thinking and feeling mediate human action. onal Association of Long Term Care Administrator Boards ❖❖ System relationships include acceptance, protection, and fostering interdependence.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learnin ❖❖ Persons and earth have common patterns and integral relations. NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION ❖❖ Person and environment transformations are created in human

National Association of Long Term Care Administrator Boards consciousness. ❖❖ Integration of human environment meanings results in adaptation (Roy, Learning, LLC2009, p. 31). © Jones & Bartlett Learning,

© Jones & Bartlett NOT FOR SALE OR DISTRIBUTION





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Cultural assumptions include the following:


Long Care ❖❖National ExperiencesAssociation within a specificof culture willTerm influence howAdministrator each element of the Roy adaptation model is expressed.

Boards

❖❖ Within aLearning, culture, thereLLC may be a concept that is central to the & Bartlett Learning, LLC © Jones & Bartlett © Jones culture that will influence some or all of the elements of the SALE OR DISTRIBUTION NOT FOR SALE ORand DISTRIBUTION NOT FOR Roy adaptation model to a greater or lesser extent.

National Association of Long Term Care Administrator Boards ❖❖ Cultural expressions of the elements of the Roy adaptation model may lead to changes in practice activities such as nursing assessment.

nes & Bartlett Learning, LLC Jones & Bartlett Learning, LLC ❖❖ As Roy adaptation model elements©evolve within a cultural perFOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION spective, implications for education and research may differ from

the experience in theAdministrator original culture (Roy, 2009, p. 31). onal Association of Long Term Care Boards

© Jonesof & the Bartlett LLC Propositions Roy Learning, Adaptation Model

NOT FOR ORpropositions DISTRIBUTION The following are theSALE relational of the Roy adaptation model (Fawcett, 2005, p. 382–383): National Association


of Long Term Care Administrator Boards

❖❖ Stimuli from the internal and external environments (through the senses) serve as inputs to the nervous system and affect the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC fluid, electrolyte, and acid–base balance, as well as the endoNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION crine system. This information is channeled automatically in the appropriate of manner, an automatic, unconscious response is National Association Longand Term Care Administrator Boards produced (Roy & Andrews, 1999, p. 46). ❖❖ Internal and external stimuli, including psychological, social,

nes & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC physical, and physiological factors, serve as inputs to the cognaFOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tor subsystem (Roy & Andrews, 1999, p. 47).

onal Association of ❖Long Term Care Administrator Boards ❖ Stimuli and adaptation level serve as input to human adaptive systems; processing of this input through control processes results in behavioral responses (Roy & Andrews, 1999, p. 43).


© Jones & Bartlett Learnin OR DISTR

❖❖NOT HumanFOR systems, as individuals, families, groups, organizations, NOT FOR SALE SALE OR DISTRIBUTION or communities, must sense changes in the environment and National Association Term Care Administrator Boards make adaptations in the way of theyLong function to accommodate new environmental requirements (Roy & Andrews, 1999, p. 44).

❖❖ Adaptation level affects the human system’s ability© to Jones respond & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC positively in a situation (Roy & Andrews, 1999, p. 36). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION




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© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION National


❖❖ The changing environment stimulates the person to make adaptive responses. the environment changes, the person has the Association of As Long Term Care Administrator Boards opportunity to continue to grow, to develop, and to enhance the meaning of life for everyone (Andrews & Roy, 1991, p. 18).

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ❖❖ The characteristics of the internal NOT and external NOT FOR SALE OR DISTRIBUTION FOR stimuli SALEinfluOR DISTRIBUTION ence the adequacy of cognitive and emotional processes (Roy &

Andrews, 1999, p. 547). National Association of Long Term Care Administrator Boards


onal Association of

❖❖ The characteristics of the internal and external stimuli influence (behavioral) responses (Roy &&Andrews, p. 547). LLC © Jones Bartlett1999, Learning,

FORasSALE DISTRIBUTION ❖❖ Human beings areNOT described adaptiveOR systems that are constantly growing and developing within changing environments. Long Term Care Administrator Boards Health for human adaptive systems can be described as a reflection of this interaction or adaptation (Roy & Andrews, 1999, p. 53–54). Learning, LLC © Jones & Bartlett © Jones &

Bartlett Learnin NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION ❖❖ The goal of nursing is the promotion of adaptation in each of the four adaptive modes, thereby contributing to health, quality of National Association of Long Term Care Administrator Boards life, or dying with dignity (Roy & Andrews, 1999, p. 55).

❖❖ The general goal of nursing intervention is to maintain and

© Jones & Bartlett Learning, LLC Jones & Bartlett Learning, LLC enhance adaptive behavior and to © change ineffective behavior to NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION adaptive (Roy & Andrews, 1999, p. 81). National Association of❖Long Term Care Administrator Boards ❖ It is the nurse’s role to promote adaptation in situations of


health and illness and to enhance the interaction of human systems with the environment, thereby promoting health (Roy & Jones & Bartlett Learning, LLC Andrews, 1999, p.©55).



Brief Critique of the Roy Adaptation Model The concepts of the Roy adaptation model are clearly and consistently

© Jonesdefined. & Bartlett Learning, LLC & Bartlett Learnin The model is internally consistent, even though it© is Jones a complex NOT FOR SALE OR DISTR NOT FOR SALE DISTRIBUTION model with OR several major concepts, subconcepts, and many relational statements. It has the level of complexity required to make it broad in National Association of Long Term Care Administrator Boards scope and generalizable for both practice and research; however, once learned, the model is logical and easy to understand (Phillips, 2010).






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T

he R oy adaptation model is commonly used

in nursing practice. To use theof model in practice, National Association Long Term Care Administrator Boards

THE Roy ADAPTATION 1. AssessLearning, the behaviors manifested from the © Jones & Bartlett LLC © Jones & Bartlett Learning, LLC MODEL ASOR A DISTRIBUTION fourOR adaptive modes (physiological–physical NOT FOR SALE DISTRIBUTION NOT FOR SALE mode, self-concept–group identity mode, role FRAMEWORK National Association of Long Term Care Administrator Boards function mode, and interdependence mode). FOR NURSING 2. Assess and categorize the stimuli for those PRACTICE nes & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the nurse follows Roy’s six-step nursing process:

behaviors.

FOR SALE OR DISTRIBUTION

onal Association of


3. Make a nursing diagnosis based on the perLong Term Care Administrator Boards son’s adaptive state. 4. Set goals to promote adaptation.


5. NOT Implement aimed at managing stimuli to promote FOR interventions SALE OR DISTRIBUTION adaptation.



6. Evaluate achievement of adaptive goals (Phillips, 2010).

Andrews and Roy (1986) pointed out that by manipulating the stimuli

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC rather than the patient, the nurse enhances “the interaction of the person NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION with their environment, thereby promoting health” (p. 51).


R

oy

specifically

addresses

incorpora -

nes & Bartlett Learning, LLC © within Jonesthe& Bartlett Learning, LLC tion of a six-step nursing process FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION context of her model, stressing that although THE NURSING

onal

are discussed for clarity, the process is Associationsteps of Long Termseparately Care Administrator Boards ongoing and simultaneous (Roy, 2009, p. 57). Roy also states in relationship to each of the steps of the nursing Jones & rely Bartlett Learning, process©that “nurses on highly developedLLC techniNOT FORand SALE OR skills DISTRIBUTION cal, interpersonal, intuitive as they assess and initiate interventions involving approaches such as National Association of Long Term Care physical care, anticipatory guidance, health teaching, and counseling (p. 59).


PROCESS AND THE Roy © Jones & Bartlett Learnin ADAPTATION NOT FOR SALE OR DISTR MODEL Administrator Boards





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Assessment


NationalThe Association of process Long Term Care Administrator Boards first step of the is the assessment of behavior—after all,

behavior is the indicator of how a human adaptive system manages to cope with, orLLC adapt to, changes in health status. Behaviors may be either © Jones & Bartlett Learning, © Jones & Bartlett Learning, LLC or non-observable (Roy, 2009, NOT p. 58). FOR In the nursing NOT FOR SALE OR observable DISTRIBUTION SALE situation, OR DISTRIBUTION the primary concern is behavior that requires further adaptive responses National Associationasof Long Care Administrator Boards a result of Term environmental changes straining the coping processes of the adaptive system. The nurse must know how to assess for these behaviors, their contribution to the nes & Bartlett Learning, LLCcompare them to specific © criteria Jonesto&evaluate Bartlett Learning, LLC maintenance of integrity, and identify the strengths of the coping proFOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION cesses and the demands faced (p. 59). onal Association of Long Term Care Boards DuringAdministrator the assessment phase of the nursing process, the nurse systematically considers behaviors manifested from the four adaptive modes the stimuli for those behaviors, categorizing them as focal, © Jonesand & assesses Bartlett Learning, LLC © Jones & Bartlett Learnin contextual, or residual stimuli (Phillips, 2010, p. 435). The nurse uses NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION observational skills, intuition, accurate measures (e.g., blood pressure Nationalreading, Association Term Care eye chart, of or Long assessment scale), andAdministrator interviewing skillsBoards to systematically collect data related to behaviors (Roy, 2009, p. 59–60). The nurse must then make a tentative judgment of the behavior. In © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC making this initial judgment as to whether a behavior is adaptive or inefNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION fective, the nurse must continually involve the patient. Ultimately, the perceptions associated with the effectiveness of behaviors are National Associationpatient’s of Long Term Care Administrator Boards essential in determining if the behavior is adaptive or ineffective (p. 61). In addition to the assessment of behaviors, the nurse must identify nes & Bartlett Learning, LLCthe internal and external© Jones Learning, LLC stimuli that & areBartlett influencing behaviors. The skills FOR SALE OR DISTRIBUTION FOR OR used for assessing stimuliNOT are the sameSALE ones that the DISTRIBUTION nurse used in assessing Care behaviors—namely, astuteBoards observation, sensitive intuition, accurate onal Association of Long Term Administrator measurement, and perceptive interview. To set priorities, the nurse, in collaboration with the patient, identifies the focal, contextual, and resid© Jonesual&stimuli Bartlett LLC © Jones & Bartlett Learnin that Learning, are influencing behavior (p. 62). In addition, “the nurse FOR NOT FOR SALEtheOR DISTRIBUTION identifies particular stimulus of the adaptation level, NOT that is, inte- SALE OR DISTR grated, compensatory, and compromised life processes that contribute to National Association of Long Term Care Administrator Boards adaptive or ineffective behavior” (p. 62). Analysis of the data results in a statement or nursing diagnosis reflective of the patient’s a nursing diagnosis within © Jones & Bartlett Learning, LLC adaptive state. In setting © up Jones & Bartlett Learning, LLC the framework of her adaptation model, Roy suggests that nurse develop NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION




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© Jones & Bartlett Learnin NOT FOR SALE OR DISTR C R I T I C A L

statements that match behaviors and the most relevant stimuli. This type of wording of the diagnosis facilitates step of goal setting 66–67). National Association ofthe Long Term Care(p. Administrator

T H I N K I N G

Boards

© JonesPlanning & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC What do you think about During the next of the nursing process, the nurse and NOT the patient setSALE NOT FOR SALE ORphase DISTRIBUTION FOR OR DISTRIBUTION

the six-step version of will promote adaptation. “The goal statement should designate not only the nursing process advocated the behavior to be observed but the way behavior will change (as nes & Bartlett Learning, LLC © the Jones & Bartlett Learning, LLC for use with the observed, measured, or subjectively reported) the time fromOR in which FOR SALE OR DISTRIBUTION NOTand FOR SALE DISTRIBUTION Roy adaptation the goal is to be attained” (Roy, 2009, p. 77). model? Do you onal Association of Long Term Care Administrator Boards believe that it allows the nurse to Implementation meet the standards © Jones & Bartlett Learning, LLC © Jones & Bartlett Learnin During the implementation phase of the process, the nurse determines of care practice NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION how best to assist the patient in attaining his or her goals and chooses requirements interventions to promote the desired through either changNational Association of adaptation Long Term Care Administrator Boards for assessment, ing stimuli or strengthening adaptive processes (Roy, 2009, p. 78). The planning, identification of possible approaches to nursing intervention includes the implementation, © Jonesselection & Bartlett Learning, LLC To make this decision,©theJones & Bartlett Learning, LLC of which stimuli to change. nurse lists and evaluation?

goals to promote adaptation. Goal setting within the framework of Roy’s

Nationalmodel Association Long of Term Careoutcomes Administrator Boards involves theof statement behavioral of nursing care that

NOT FOR DISTRIBUTION NOT FOR theSALE stimuli OR affecting specific behaviors and identifies the relevant copingSALE OR DISTRIBUTION Then theof consequences of changing the stimulus or affecting a Nationalprocesses. Association Long Term Care Administrator Boards

coping process are identified together with the probability (low, moderate, or high) of their occurrence. In collaboration with the patient, the nurse judges the outcome desirable or undesirable nes & Bartlett Learning, LLC of the consequence as©either Jones & Bartlett Learning, LLC (p. 79). Once the appropriate nursing intervention has been selected, the FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION nurse works with the patient to initiate steps that will alter the stimulus onal Association of Long Term Care Administrator Boards and enhance coping (p. 80).

© Jones & Bartlett Learning, LLC Evaluation



Evaluation focuses on judging the effectiveness of the nursing intervention in National relation to the behavior of theof individual or group. To determine if Association Long Term Care Administrator Boards the adaptive goals have been met, the nurse uses the same skills as were employed in the assessment phase of the process—observation, intuition, Jonesmeasurement, & Bartlett and Learning, LLC © Jones & Bartlett Learning, interviewing (Roy, 2009, p. 81).

© NOT FOR SALE OR DISTRIBUTION





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T

he following scenario illustrates nurs -

ing care of the patient relative to one identified National Association of Long Term Care Administrator Boards

SCENARIO nursing problem framed by Roy’s adaptation model. This scenario is not intended to cover all ILLUSTRATING © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC aspects of care, but rather is intended to stimulate CARE NOT FOR NURSING SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION thinking about how specific care might be approached FRAMED BY THE thisAdministrator theory as a framework for practice. National Association of Long Termusing Care Boards Roy ADAPTATION MODEL UTILIZING nes & Bartlett Learning, LLC © isJones & Bartlett Learning, Mrs. M. a 37-year-old single mother with twoLLC schoolTHE NURSING FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION age children. Mrs. M. suffered multiple facial injuries PROCESS as a result of a motor vehicle accident several months


ago. The injuries have healed without complication, but she has moderate residual scarring. © Jones & Assessment Bartlett Learning, LLC with the behaviors manifested © Jones & Bartlett Learnin of Mrs. M. begins from NOT FOR NOT FOR SALE OR DISTRIBUTION the four adaptive modes. The nurse uses observational skills, intuition,SALE OR DISTR and interviewing skills to collect data. The nurse involves Nationalmeasurements, Association of Long Term Care Administrator Boards Mrs. M. in the assessment to verify the nurse’s own perceptions. The nurse verifies that Mrs. M. has generally adapted well following the motor © Jones & Bartlett Learning, LLC The exception is the self-concept © Jones mode: & Bartlett LLC vehicle accident. Some ofLearning, her NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION behaviors are ineffective in relation to adaptation, as evidenced by Mrs. M.’s avoidance of social gatherings, wearing dark glasses and big hats, National Association of Long Term Care Administrator Boards and wearing heavy makeup to cover her scars. Next, the nurse and Mrs. M. set goals to promote adaptation. Goal setting framework statements of measurable nes & Bartlett Learning, LLC for Mrs. M. within the © Jones & involves Bartlett Learning, LLC behavioral outcomes of nursing care that will promote adaptation related to FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION body image within the self-concept adaptive mode. The nurse, in collaboraonal Association of Long Term Administrator Boardsbased on current best practices to tionCare with Mrs. M., chooses interventions promote adaptation by either changing stimuli or strengthening Mrs. M.’s processes. EvaluationLLC focuses on judging the effectiveness of the © Jonesadaptive & Bartlett Learning, © Jones & Bartlett Learnin nursing interventions in relation to Mrs. M.’s behaviors. In addition, if any NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION other nursing problems are uncovered during the assessment, the nurse National Association of Long Term Care Boards addresses those problems simultaneously usingAdministrator the process described and incorporating best practices to provide appropriate nursing care.






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C l as s r o o m A c t i v i t y 1 0 - 1


Form small groups. Each group should add to the plan of care for Mrs. M. in the preceding scenario based on other potential or actual © Jones &nursing Bartlett Learning, © Jones & Bartlett Learning, LLC problems typical LLC for a patient with same medical diagnosis NOT FOR SALE OR DISTRIBUTION NOT FOR or symptoms and demographics. Each group should develop a planSALE OR DISTRIBUTION for one additional nursing problem using Roy’s theory as the basis for National Association of Long Term Care Administrator Boards practice, while considering at least one of the four adaptive modes. Each group should then share its plan with the class.



C l as s r o o m A c t i v i t y 1 0 - 2

onal Association ofForm Long Term Care Administrator Boards small groups. Using a case study provided by

the instructor, develop a plan of care using Roy’s nursing theory as the basis for practice. Each group should then share its plan © Jones & Bartlett Learning, LLCof care with the class.



C l asNational s r o o mAssociation A c t i v i t yof1Long 0 - 3 Term Care Administrator Boards Form small groups. Using a case study provided by the instructor, a plan of care using one of the theories as the © basis for prac© Jones &develop Bartlett Learning, LLC Jones & Bartlett Learning, LLC tice; each group should select a different nursing theory. Each groupSALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION NOT FOR should then share its plan of care with the class and discuss the simiNational Association of Long Term Care Administrator Boards larities and differences in care.










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REFERENCES


Andrews, H. A., & Roy, Sr. C. (1986). Essentials of the Roy adaptation model. Norwalk, CT: Appleton-Century-Crofts. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Andrews, H. A., & Roy, Sr. C. (1991). Essentials of the Roy adaptation NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION model. In Sr. C. Roy & H. A. Andrews (Eds.), The Roy adaptation definitive (pp. 2–25).Boards Norwalk, CT: Appleton National Association ofmodel: LongThe Term Carestatement Administrator & Lange. Fawcett, J. (2005). Contemporary nursing knowledge development: nes & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Analysis and evaluation of nursing models and theories (2nd ed.). FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Philadelphia: F. A. Davis. Phillips, D. (2010). Sister Callista Roy: Adaptation model. In A. M. onal Association of Long Term CareK.Administrator Boards Tomey & M. R. Alligood (Eds.), Nursing theorists and their work (7th ed., pp. 335–365). Maryland Heights, MO: Mosby. © JonesRoy, & Bartlett Learning, LLC © Jones & Bartlett Learnin Sr. C. (1970). Adaptation: A conceptual framework for nursing. NOT FOR SALE OR DISTR NOT FOR SALE OR DISTRIBUTION Nursing Outlook, 18, 42–45. Sr. C. (2009). of TheLong Roy adaptation model (3rd ed.). UpperBoards Saddle NationalRoy, Association Term Care Administrator River, NJ: Pearson. Roy, Sr. C., & Andrews, H. A. (1991). The Roy adaptation model: The © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC definitive statement. Norwalk, CT: Appleton & Lange. NOT FOR SALE OR DISTRIBUTION NOT FOR ORed.). DISTRIBUTION Roy, Sr. C., & Andrews, H. A. (1999). The Roy adaptationSALE model (2nd CT: Appleton & Lange. National Association ofStamford, Long Term Care Administrator Boards Roy, Sr. C., & Roberts, S. (1981). Theory construction in nursing: An adaptation model. Englewood Cliffs, NJ: Prentice-Hall.










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