Running head: ROYS ADAPTATION MODEL

Roys Adaptation Model

Paloma Garcia Duran, Sophia Jones, Amanda Mudge, Christina Tep, and Kayla Witmer
Sam Houston State University The Woodlands Center
NURS 3351 Nursing Concepts I

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Roys Adaptation Model
Introduction

Nurses have the social responsibility of providing appropriate care, protecting the
patients, and optimizing the healthcare system (ANA, 2010). To fulfill such responsibility
towards society, nurses need to implement evidence-based practice (EBP) in their nursing
careers, which is based on the best available evidence, patient preferences, and clinical
judgment (Schmidt & Brown, 2015, p. 4). To implement EBP, nurses need to analyze research,
which requires an understanding of the nursing theories. One of the theories that has impacted
nursing the most is Sister Callista Roys Adaptation Model (RAM), which started its
development in the 1960s. For Roy, nursings social responsibility is to incorporate adaptation in
the clinical setting with the purpose of contributing to health, quality of life, and dying with
dignity (Roy, 2011, p. 346).
Discussion of Nurse Theorist
Roy was born on October 14, 1939 in Los Angeles, California. Her mother worked as a
licensed vocational nurse and provided her with the foundation of the values of caring for others
and selfless giving. Roy was surrounded with strong religious beliefs which led her to enter the
Sisters of Saint Joseph of Carondele in which she later became "Sister Callista Roy (Parker &
Smith, 2010, pp. 167-168). Roys admiration for the nursing profession began when she was 14
years old, while working at a hospital as a maid, pantry girl, and nurses aide (Parker & Smith,
2010). The experience she received at the hospital led her to pursue a nursing degree. She
received her Bachelor of Science Degree in Nursing in 1963 at Mount St. Marys College in Los
Angeles, California. In 1966, Roy received her masters degree in Pediatric Nursing followed by
a Ph.D. in Sociology at the University of California in Los Angeles. Also, Roy completed a two

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year Postdoctoral Fellowship in Neuroscience at the University of California in San Francisco

(Parker & Smith, 2010).
Roys experience in her academic career led to the development of her Roy Adaptation
Model. While attending the University of California in 1964 in pursuit of a masters degree in
Pediatric Nursing, Roy enrolled in a course that influenced the development of her theory. As a
student, under the mentorship of Professor Dorothy E. Johnson, Roy was given an assignment to
describe her understanding of the goal of nursing. Her response was that the goal of nursing is
to promote adaptation (Clarke, Barone, Hanna & Senesac, 2011, p. 337). Roys experience in
pediatric services reinforced her idea of nursing that emerged from Johnsons class. Roy was
impressed by the adaptation capacity of children (Equipo organizador del Primer Congreso
Internacional de Enfermeria, 2013, p. 180). After combining her idea of adaptation with the
theoretical bases of the Systems and Evolutionary theories, she published her Adaptation Model
in 1970. (Roy, 1984). Roy is currently a professor at Boston College and continues to update,
revise, and expand her theory (Connel School of Nursing, 2015).
Discussion of Theory
The Roy Adaptation Model defines the metaparadigm of nursing, which is person,
health, environment, and nursing (Creasia & Friberg, 2011). Philosophically, Roy believes
people are: (a) valuable and worthy of respect and care, (b) responsible for making decisions
about the direction of their own lives, and (c) thinking, feeling beings who work
interdependently with others to create society (Phillips, 2011). Physiologically, the person is an
adaptive system with cognator and regulator acting to maintain adaptation in regard to the four
adaptive modes (Roy, 1984, p. 36). For Roy (1984), a system is a set of units related to form a

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unity that functions with interdependence of its parts, inputs, outputs, and control and feedback
processes (Roy, 1984, p. 30). The person receives stimuli (input), produces a response through
control processes (coping mechanisms), and through effectors, sends a response (output) that is
regulated by feedback. (Roy, 1984).
According to Roy (1984), the two basic internal processes of the person as a system are
the regulator and cognator subsystems (p. 31). The regulator receives input from external and
internal environments, then processes the changes through the central nervous system and
produces a response. The cognator receives the inputs and processes them through cognitive or
emotive pathways (Roy, 1984). These stimuli trigger four kinds of processes:
perceptual/information processing, learning, judgement, and emotion (Roy, 1984, p. 33).
According to the RAM, the person tries to adapt to aforementioned processes through four
adaptive modes: (a) physiology, (b) self-perception, (c) role domain, and (d) interdependence.
Physiologically, the person responds to Maslows basic needs (i.e., eating, and breathing). For
successful self-reflection, the person responds to changes of the environment. In the role
domain, the person adapts to the different roles that he or she occupies in society, such as parent,
priest, or lawyer. Lastly, in the interdependence role, the person needs to adapt to socialize in
society (Equipo organizador del Primer Congreso Internacional de Enfermeria, 2013).
According to the RAM, the environment consists of internal and external stimuli that the
person receives. These stimuli include all conditions, circumstances, and influences

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surrounding and affecting the development and behavior of persons or groups (Roy, 1984, p.
39). In other words, the person should adapt to the stimuli.
In the RAM, the goal of nursing is to promote adaptation in the four adaptive modes,
contributing to health, quality of life, and dying with dignity (Roy, 2011, p. 346). To promote
adaptation, nurses must carry out two types of actions. One is evaluating the patients situation
and the other is the direct intervention on the patient through the nursing process (Equipo
organizador del Primer Congreso Internacional de Enfermeria, 2013, p. 180). This means that
the nurse can help the patient to adapt to the different stimuli that the patient receives.
Roy (1984) defined health as a state and a process of being and becoming an integrated
and whole person (p. 39). Adaptation frees the person to adapt to the next stimuli that receives
and releases an energy that can promote healing and enhance health (Roy, 1984, p. 38).
Therefore, health is achieved through effective adaptation to stimuli.
Roy (1984) believes that persons or adaptive systems interact with environment and
move toward the goal of adaptation and health. The nursing process based on the model
influences that movement (p. 40). In other words, the nurse promotes adaptation by modifying
the environment, or external stimuli, to help patients recover their health. These statements show
the relationship among the concepts that constitute Roys conceptual framework.
Application of Theory
When applying the RAM to the nursing process, two levels of assessment are included.
The first level addresses the patients behavior, which will either be adaptive or ineffective.

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Adaptive behaviors will assist the patient in reaching positive and healthy goals, whereas
ineffective behaviors will not (Roy, 2009). A patient will exhibit either observable or
nonobservable behavior. Nonobservable behavior should be described by the patient and in their
own words, whereas observable behavior is what others can see. The nurse needs to identify
these types of behavior to help the patient learn how to adapt to the stimuli (Roy, 2009).
The second level of assessment addresses the stimuli, whether internal or external. The
nurse should observe the patient, be intuitive, acquire measurements, and ask questions to
identify the stimulus. The stimulus is considered to be focal, contextual, or residual. Focal
stimulus is the most direct cause of the observed behavior. For instance, someone may exhibit a
fight or flight response if they see a bee flying near them; the bee is the focal stimulus (Roy,
2009). Contextual stimuli lead to the manners produced by the focal stimuli. Example, the
person seeing the bee flying around may be allergic to bees, which will be the reason they move
away from the bee; the bee allergy is the contextual stimuli. Roy (2009) stated that residual
stimuli are defined as those having an indeterminate effect on the behavior of the individual or
group adaptive system (p. 64). Two ways to interpret residual stimuli exist: first, the patient can
confirm that the stimulus is affecting them and second, the nurse can use her gained knowledge
and experience to determine if the stimulus is affecting the patient. Consider, again, the person
allergic to the bee may have had a severe allergic reaction once before, and is afraid that it might
happen again. When assessing the patients stimuli, it is necessary to keep in mind that the

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stimuli can change according to different circumstances. The stimuli may start out as residual,
and then quickly become focal.
Roy (2009) defines nursing diagnosis as a judgment process resulting in statements
conveying the adaptation status of the individual or group (p. 66). When using the RAM to help
develop a nursing diagnosis, Roy suggests creating a statement that connects the prominent
stimuli with the patients behaviors. For example, the person allergic to bees actually gets stung
and begins to have trouble breathing. A nursing diagnosis for this patient could be Impaired
Spontaneous Ventilation r/t acute airway obstruction from anaphylaxis process (Ackley &
Ladwig, 2014, p. 24). The patients behavior, impaired spontaneous ventilation, and the
stimulus, anaphylaxis process, are both mentioned in the diagnosis.
The idea of setting a goal is to support adaptation and to change ineffective behavior to
adaptive (Roy, 2009, p. 76). When setting goals, the nurse needs to state specific outcomes for
the patients behavior that encourage adaptation. The goal needs to clearly state the observed
behavior, the change in behavior, and a time frame for the goal to be accomplished (Roy, 2009).
For example, the patients respiratory rate will stabilize (behavior) to a range of 12-20 breaths
per minute (change expected) within 15 minutes (time frame) of receiving medical treatment.
The purpose of nursing interventions is to encourage adaptation by changing or removing
stimuli and by promoting the patients adaptive process. The nursing interventions ensure that
the goals are met. Changing the stimuli will help the patient become more capable of adaptation.
A nursing intervention for the patient with impaired ventilation from a bee sting could be

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removing as many people from the room as possible to help reduce anxiety. An intervention for
promoting the adaptive process could be to practice breathing exercises with the patient until the
medication becomes effective (Roy, 2009).
Lastly, the nurse needs to evaluate the effectiveness of the interventions and determine if
the goals were met by talking to the patient and utilizing observation, intuition, and
measurements. For the patient with impaired ventilation, the nurse can measure his or her
respiratory rate to ensure that it is within normal limits. If the goals were not met, the nurse must
further investigate to find what prevented the patient from achieving the goals (Roy, 2009).
Conclusion
We view the Roy Adaptation Model as a holistic, evolving model that nurses can directly
apply to their practice. Roy approached her model in a scientific and systematic way in an
attempt to guide the nursing process. Her background in pediatric services gave her insight on
the important relationship between health and adaptation. The three concepts of the model are
person, health, and nursing, all of which are considered successful when they have become
properly adapted. These concepts adapt due to changes in internal and external stimuli. The role
of the nurse is to promote the adaptation of the individual in response to the various stimuli. We
believe that the focus on adaptation is what makes this theory continue to be applicable in
modern nursing practice. Sister Callista Roys adaptation model inspires healthcare
professionals to view patients as continuously evolving, biopsychosocial beings. Applying this
theory leads to patient-centered care for each patient as they adapt. We agree that by following
her model of adaptation, nurses are able to provide better and more individualized care.

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References

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planning care (10th ed.). Mosby. VitalBook file.
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Nursing Science Quarterly, 24(4), 337-344. doi: 10.1177/0894318411419223
Connel School of Nursing. (2015). Sr. Callista Roy, PhD, RN, FAAN: Professor and nurse
theorist. Boston College. Retrieved from
http://www.bc.edu/schools/son/faculty/featured/theorist.html
Creasia, J. L., & Friberg E. E. (2011). Conceptual foundations: The bridge to professional
nursing practice, (5th ed). St. Louis, MO: Elsevier & Mosby.
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Roy, C. (1984). Introduction to nursing: An adaptation model, (2nd ed.). Englewood Cliffs, NJ:
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