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Running head: ROY’S ADAPTATION MODEL
Sister Callista Roy: Adaptation Model for Nursing
Bailey Sundberg, Sara Tonder, Amy Wirick
Ferris State University
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ROY’S ADAPTATION MODEL
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Abstract
The purpose of this paper is to introduce Sister Callista Roy as a nursing theorist, and the
Adaptation Model she created for nursing. Included in the paper is: a biography of the theorist,
major concepts of the nursing model related to the nursing paradigm, theoretical underpinnings,
and an example of the theory applied to a clinical setting.
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Table of Contents
I: Introduction/ Biography
p.4
II: What is the Adaptation Model?
p.4
III: Defining the Major Concepts of Model
p.5
IV: Theoretical Underpinnings
p.7
V: Clinical Applications
p.8
VI: References
p.11
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Sister Callista Roy: Adaptation Model for Nursing
Sister Callista Roy was born in 1939. In 1963 she graduated from Mount Saint Mary’s
College in Los Angeles with her Bachelors in Science of Nursing (BSN) Degree. Three years
later she completed her Masters in Science of Nursing (MSN) Degree at the University of
California, where she also later earned her masters and doctorate degrees in sociology. Roy
began working on the Adaptation Model for Nursing when her graduate level professor and
soon-to-be fellow theorist Dorothy E. Johnson, “challenged [her] to develop a conceptual model
for nursing” (Philips, 2010, p. 335). Two years later Roy’s Adaptation Model (RAM) was
accepted into the curriculum of her alma-mater, Mount Saint Mary’s College of Nursing, where
Roy herself worked until 1983. She then helped the University of Portland initiate a MSN
program, worked as a clinical nurse scholar in neuroscience for the University of California, and
created the nurse theorist position at Boston College where she remains a professor today
(Philips, 2010, p. 336).
What is the Adaptation Model?
Roy’s Adaptation Model (RAM) incorporates the four paradigms of nursing: person or
human being, environment, health, and nursing. In general, the model states that when a stressor
or stimuli presents itself to a person, the person responds both consciously and unconsciously. If
adaptation levels are compromised, the overall health of the person and their ability to adjust to
changes in their environment are jeopardized.
Sister Callista Roy explains in a 2009 article, that the definition of person includes
“people as individuals or as groups such as families, organizations, communities, and society as
a whole” (Roy, Whetsell, & Fredrickson, 2009, p.209). Roy continues by defining environment
as, “all conditions, circumstances, and influences that surround and affect the development and
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behavior of people as adaptive systems with particular consideration of human and earth
resources” (Roy, Whetsell, & Fredrickson, 2009, p.209).To support the metaparadigm of health
the model discusses psychosocial, physiological, and physical functioning. Any dysfunction
results in the person having adaptation problems, which leads to the final paradigm of nursing.
Nursing must evaluate for, and be aware of, the dysfunctions in order to support a patient
through a productive adaptation process based on the change in environment.
Defining the Major Concepts of Model
The major concepts of RAM need to be defined to understand the theory and those
definitions are best given by Sister Callista Roy. While there are many other terms used in the
model: system, stimuli, coping process, and the four adaptive modes are the fundamentals.
System
A person’s ability to adapt to changes is reliant on the different parts of the system
working together at maximum potential. According to Roy, “systems also have inputs, outputs,
control and feedback processes” (qtd in Philips, 2010, p. 337). If any part of the system becomes
unbalanced, it may result in the counterparts to malfunction or overcompensate, which will
disrupt the adaptation process as a whole.
Stimuli
A person is affected environmentally by three different types of stimuli: focal, contextual
and residual. According to Roy, focal stimulus can be either internal or external, and is the
“stimulus immediately confronting the human system” (Philips, 2010, p. 338). Contextual
stimuli occur with a specific focal stimulus but are “not the center of the person’s attention
and/or energy” (Philips, 2010, p. 338). Finally, residual stimuli Roy defines as the
“environmental factors within or without the human system with effects in the current situation
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that are unclear” (Philips, 2010, p. 338). Residual stimuli could be the consequences of the
choices made related to a person’s health, illness, or adaptation process. An example of the three
types of stimuli would be: a person is diagnosed with cancer which would be the focal stimuli,
the side effects of treatment would be the contextual stimuli, and the residual stimuli would be
the high medical expenses faced in remission.
Coping Processes
The inclusion of the metaparadigm health begins with the coping processes. Roy says that
coping processes “are innate or acquired ways of interacting with the changing environment”
(Philips, 2010, p. 338). The regulator coping process is an innate mechanism, meaning a person
is born with this ability, and the cognator coping process is acquired or learned through life
experiences. (Philips, 2010, p. 338)
Four Adaptive Modes
There are four adaptive modes used in Roy’s theory: physiological-physical, self-concept,
role function, and the interdependence modes. Briefly, the physiological-physical mode is
equivalent to Maslow’s first hierarchy of needs: oxygen, nutrition, elimination, activity, rest, and
safety. Without the person successfully fulfilling this mode of basic survival needs, none of the
others will be obtainable. The self-concept-group identity mode says that a person needs to
“know who one is so that one can be or exist with a sense of unity, meaning, and purposefulness
in the universe” (Philips, 2010, p. 339). The role function mode refers to the person’s role within
society and includes primary, secondary and tertiary roles. The final mode, the interdependence
mode, deals with the relationship building and the status of relationships for the person (Philips,
2010, p. 339-40).
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Theoretical Underpinnings
The foundations used to begin the growth of a theory are known as, theoretical
underpinnings. According to Moreno, Duran, & Hernandez (2009), “the process of choosing a
nursing theory requires that nurses delve into the philosophical underpinnings of the theory in
order to determine the values of the model, and the implications that these values have for
nursing care” (p. 67). Sister Callista Roy used the work and citations from others as a strong
foundation for her final model.
Underpinnings from Harry Helson
The Adaptation-Level Theory by Harry Helson is an experimental and systemic approach
to behavior used by Roy in the RAM development. She included Helson’s idea that “adaptive
responses are a function of the incoming stimulus and the adaptive level” (Philips, 2010, p. 336),
from this Roy went on to develop the three classes of stimuli. She also used Helson’s idea of the
adaptation level zone which defined adaptation as “the process of responding positively to
environmental changes” (Philips, 2010, p. 336).
Other Underpinnings
Roy developed the theories of self-consistency and self-concept using the work of the
Arthur Coombs and Donald Snygg. Social interaction was also part of Roy’s theory and she used
the work of Charles Cooley’s term the “looking glass self” to “theorize that self-perception is
influenced by perceptions of others’ response” (Philips, 2010, p. 337). Roy continued on with her
theory of adaptation by using the work of Mead and Sullivan. Mead helped Roy “expand the idea
by hypothesizing that self-appraisal uses the generalized other” (Philips, 2010, p. 337). Roy
developed her theory regarding social interaction based on the information Sullivan suggested to
her which was that one’s self comes from the interaction you have with other individuals.
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Clinical Applications
The Roy Adaptation Model (RAM) focuses on how humans adapt to an ever changing
environment (Kearnney-Nunnery, 2008, p. 62). This model has been used successfully in
providing nursing care to pregnant patients experiencing nausea and vomiting (NVP).
Environmental Stimuli
Nurses assess patient behaviors, which include how a patient responds to stimuli through
adaptation. The nurse’s goal in RAM is to promote adaptation. In pregnancy, 50-80% of women
experience nausea and vomiting (Isbir & Mete, 2010). The focal stimulus in this example is:
pregnancy, nausea, and vomiting. Further, contextual stimuli “are the stimuli that potentiate focal
stimuli” which may include: smells, poor nutrition, inadequate support system, decreased ability
to cope with stress, insufficient adaptation to pregnancy, and focusing on fetal health (Isbir &
Mete, 2010, p. 151).
Coping Mechanisms in Response to Changing Stimuli
When a person experiences environmental stimuli there are two types of coping systems
a person uses to adjust to the change, the regulator and cognator coping subsystems. Recall that
the regulator system is an innate coping process, where the cognator system is a learned coping
process. When the focal stimulus of NVP is mild or moderate, and evident in the first and half of
the second trimester, it can be assumed that these patients have effective cognator and regulator
systems. Had the NVP been labeled as severe, it could be said that the patient is not adapting to
the focal stimulus by focusing on the changes to the contextual stimuli that potentate the NVP. If
the changes in the physiological mode are positive, any non-adaptive behavior present in other
modes will begin to compensate. (Isbir & Mete, 2010).
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Evaluation of Behaviors in Response Modes
According to Isbir and Mete (2010) the physiological-physical needs of a person to
maintain human integrity are: oxygenation, nutrition, elimination, protection, activity/rest,
senses, fluid-electrolyte and acid-base balance, neurological, and endocrine functions. Of these
components seven are associated with nausea and vomiting (elimination) in pregnancy. N/V can
have a direct effect on inadequate nutrition, increased sensitivity to smells (senses), ketoacidosis
(acid-base imbalance), hypokalemia (electrolyte imbalance), dehydration (fluid imbalance),
weakness and tiredness (activity and rest) (Isbir & Mete, 2010). Adaptation to the stimuli in the
physiologic mode is imperative for any type of health to occur, and before focus can turn to the
next three modes.
The final three modes continue with the self-concept mode which deals with the physical
and personal self. Frequent behaviors related to the physical self in NVP are feelings of “being
untidy, messy, pale, and underweight” (Isbir & Mete, 2010). The personal self can include
individual “characteristics, expectations, values, self-confidence, ideal, and moral-ethicalspiritual values” (Isbir & Mete, 2010). Further, the role function mode focuses on activities of
daily living. NVP can impact a woman’s life as well as each of her family members. Consistent
nausea and vomiting can debilitate a woman as she may not be able to perform her usual role
functions or tasks which can lead to a feeling of loss of control or independence. Finally, the
interdependence mode involves personal relationships, and with NVP a woman may experience
disrupted relations with her husband. Husbands may not realize that the inability of the woman to
control nausea and vomiting is the only reason for the change in relationship characteristics that
were considered normal prior to pregnancy. A person experiencing an under-developed mode
could indicate or lead to a non-adaptive behavior (Isbir & Mete, 2010).
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Nursing Interventions
After the nurse evaluates stimuli, coping systems, and modes, evaluation and goals can
occur. Educational information should be offered to women with NVP that includes the causes of
nausea and vomiting in pregnancy. Patients should be instructed on staying away from odors,
remaining in well ventilated areas, rising from bed slowly and to avoid sudden movements. The
nursing goal in NVP is to decrease or eliminate nausea and vomiting, and to assist the patient
with positive changes in her physiological mode. By supporting the patient in a balanced
physiological mode, changes in the following modes can occur to rid the patient of non-adaptive
behaviors.
The major concept of Sister Callista Roy’s adaptation model is adaptation. The focus is
how humans respond to an ever-changing environment. Roy uses the four paradigms of nursing
as a framework for her model. She states that overall health of a patient depends on the conscious
and unconscious ways that an individual copes to changing stimuli. Nurses play an important
role implementing approaches that can either change the stimuli, or strengthen the adaptive
process (Kearney-Nunnery, 2008, p. 64). Since our environment is forever changing, Roy’s
adaptation model will always be relevant in nursing care.
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References
Duran, M. M., Hernandez, A., & Moreno, M. E. (2009). Nursing care for adaptation. Nursing
Science Quarterly, 22(1), pp. 67-73. doi: 10.1177/0894318408327296
Isbir, G.G, Mete, S. (2010). Nursing care of nausea and vomiting in pregnancy: Roy adaptation
model. Nursing Science Quarterly, 23(2), pp. 148-155. doi: 10.1177/0894318410362489
Kearnery-Nunnery, R. (2008). Advancing your career: Concepts of professional nursing.
Philadelphia, PA: F.A. Davis Company.
Phillips, K.D. (2010). Sister Callista Roy. In M. R. Alligood, & A. M. Tomey (Eds.) Nursing
theorists and their work (7th ed., pp. 335-365). Maryland Heights, Missouri: Mosby
Elsevier.
Roy, C., Whetsell, M.V., & Frederickson, K. (2009). The Roy adaptation model and research:
Global perspective. Nursing Science Quarterly. 22, pp 209-211. doi:
10.1177/0894318409338692