roy's adaptation model

APPLICATION OF ROY’S ADAPTATION MODEL 1

Application of Roy’s Adaptation Model

br. Jose Francisco Pereira, OSGC

National University San Diego

January 29, 2012


Nursing Theory Models are co-related in between theory, education, research, and

clinical practice, working as a guide in all areas with this interaction assuring that the nursing

profession stay relevant and continuous positively influencing the patient’s health.

Many Nurses have developed theories to define or explain various aspects of the nursing

profession, and becoming a step-by-step set of ideas and “concepts that hold true as a constant

and can be used to treat patients, describe and explain illnesses and their subsequent cures,

predict facets of cause, reaction and outcome, and prescribe a healing course of action. Nursing

theories can be viewed as the field establishing its professional boundaries as the main

component of caring is impossible to measure. The theories also seek to define what it is that

nurses know and do as a separate autonomous discipline that is only recently being granted its

autonomy.” (Topnursingcolleges.com. n.d.)

Sr. Roy’s, encouraged by Johnson’s nursing model, in 1976 developed the Roy’s

Adaptive Model (RAM) which incorporate concepts from, Helson’s adaptation theory, Von

Dohrenrend and Seyye, and Lazarus’s coping model (Philips, 2002). RAM understands a person

as an interrelated system, biological, psychological, and social.

Understanding Roy’s Adaptive Model

RAM describes a person as “an adaptive system with cognator and regulator subsystems

acting to maintain adaption in the four adaptive modes” (Roy, 2009): physiologic-physical, self-

concept-group identity, role function and independence (Figure 1). It also takes in consideration

an interdependency between person and resources, where the person is a whole in the family,

groups, community, society, organizations, and nation, with their environment been related to

“all conditions, circumstances, and influences surrounding and affecting the development and

behavior of persons and groups, with particular consideration of mutuality of person and earth


resources” (Roy, 2009).All of those are divided in three kinds of stimuli: focal with an

immediate effect, contextual is a contributory circumstance, and residual which is related to

residual beliefs or attitude from a past experience (Alexander, Fawcett, & Runciman, P. J. 2006).

Health is “a state and process of being and becoming an integrated and whole that reflects

person and environment mutuality” (Roy, 2009), where health, wellbeing, and illness can co-

exist (Phillips, 210) in a continuum. Nursing is “to promote adaptation for individuals and groups

in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by

assessing behavior and factors that influence adaptive abilities and to enhance environmental

factors” (Roy, 2009).

Figure 1: Sr. Roy’s Adaptation Model (RAM)

Source: Roy & Andrew, 1999.

RAM, defined adaptation as "the process and outcome whereby the thinking and feeling

person uses conscious awareness and choice to create human and environmental integration"

(Roy, 1997) through a “creation spirituality” concept, which understand that the “person and the


earth are one, and that they are in God and of God” (Roy, 1997). Moreover the person and the

environment as sources of stimuli and both needs modification to promote adaptation in four

modes - physiologic, self-concept, role function, and interdependence - to obtain health

behavioral results, with each patient’s adaptation model being unique and in constant change.

Roy’s Adaptive Model Nursing Process

RAM nursing process is a problem solving approach where in each of the four adaptive

modes, where the RN will need to:

1. Assess the Behavior “of the person as an adaptive system in each in each of the

adaptive modes.” (Marinquez, D. J. S., 2009)

2. Assess and identify the internal and external stimulus, “that are influencing the

person’s adaptive behaviors. Stimuli are classified as: 1) Focal – those to most

immediately confronting the person; 2) Contextual – all other stimuli present that are

affecting the situation and 3) Residual – all other stimuli present that are which

descripts the adaptive system; internal and external stimulus influencing patient’s

adaptive behaviors for each of the adaptive modes.” (Marinquez, D. J. S., 2009)

3. Nursing diagnosis “involves the formulation of statements that interpret data about

the adaptation status of the person, including the behavioral and the most relevant

stimuli.” (Marinquez, D. J. S., 2009)

4. Goal Setting “involves the establishment of clear statements of the behavioral

outcomes for nursing care.apply interventions based on patient center care plan

(implementation).” (Marinquez, D. J. S., 2009); “Goals need to be realistic and

attainable and are set in collaboration with the person.” (Andrews & Roy, 1991)


5. Intervention “involves the determination of how best to assist the person in attaining

the established goals” (Marinquez, D. J. S., 2009); adapt “the principles of the model

and the development of multi-modal training tools for your learners, including just-in-

time training and use of adult learner principles; attending to issues of authority,

leadership style and communication.” (Senasec.2010)

6. Evaluation is “final step of the nursing process which involves judging the

effectiveness of the nursing intervention in relation to the behavior after the nursing

intervention in comparison with the goal established.” (Marinquez, D. J. S., 2009).

During this phace, if any ineffective behaviors are observe, the RN will start all

process again.

Practical application of the model in a case study (Attachment)

When a nurse is applying RAM to her daily life is difficult to separate person, health,

environment, and nursing since they are all interrelated, see figure 1.

Sr. Roy’s model is been apply to case study 4, which describes a new patient to the clinic

who is coming to see the RN Certified Diabetic Educator (CDE). Being the first nursing

consultation, the CDE is evaluating Ms. Brown medical data, coping strategies (adaptive),

knowledge of her medical condition, the ability to recognized personal habits, internal and

exterior stressor, which collaborate towards preventing her to obtain optimum health. The goal of

the nurse is to assist Ms. Brown developing an effective adaptive system towards her health and

illness.

In the clinical setting the CDE, review clinical data from the Ms. Brown chart notice that

she is 45 years-old African-American female with a family history of type 2 diabetes and a

history of with mild hypertension which is under control with medication, and dyslipidemia in


the past 2 years. Ms. Brown has a body mass index (BMI) of 30kg/m2, with a waist

circumference of 40 inches. Her most recent blood work shows A1C level as at 7.3% and fasting

glucose levels average between 140 and 160mg mg/dl; no others blood work are available at this

time.

During nursing interview, the CDE noted that Ms. Brown has recently become divorced

and is a single mother of an age eight years old son and a five years old daughter; recently move

to a new area in the same apartment complex as her mother who can provide after school care for

her children; unable to lose the weight gained during both pregnancies; lives a sedentary live due

to working as an administrative assistant; unable to have free time to herself due to working and

family obligations. She also stated feeling frequent tiredness and some paresthesias in her lower

extremities, mainly burning sensations that come and go in her calf muscles and the top of her

feet.

The nurse recognized that Ms. Brown is dealing with three major life changing events,

recently divorce, becoming sole care giver of two young children, and her new residential status

which create new stresses such as how to: 1) effectively provide economically for her family,

which may require more time at work or even obtain a part-time job; 2) to find new ways to care

for her children, being a single mother there is not a partner to share this obligation and her

mother may become ill or may will have personal schedule conflicts with the aftercare for the

children, and children adaptation of having only one parent at home; 3) new residential status,

which can create sense of insecurity related to new area adaptation for her and the children,

transportation to and from work, and finally the children adaptation to new school which can

direct influence theirs behavior. Each of these factors can provide internal and external stressors,

creating an imbalance to previous coping strategies that Ms. Brown used to deal with her


Hypertension, dyslipidemia and maybe is causing her type 2 diabetes to be out of acceptable

parameters.

The CDE goal following RAM is to understanding how Ms. Brown life use to be and

how she use to feel before her divorce, how she is feeling with her new family system and

residential situation, meals choice and preparation, what she knows about type 2 diabetes, the

correlation between type 2 diabetes with cardiovascular disease, and exercises. After these

understanding is gain, the nurse can develop a nursing care plan with Ms. Brown towards assist

her to obtain control of her type 2 diabetes, maintain her hypertension and dyslipidemia under

control, make better meals choices, increase physical activity, and prevent depression. This goal

can be obtain by Listening With the Heart (Hwoschinsky, 2002) to Ms. Brown, answer her

question in a non-judgmental way, referral to dietician and social-worker consultation, and start

an open line of communication with clinic nurse case manager to answer any further question

that she may encounter. Moreover provide reading and visual materials developed by the

American Diabetes Association related to diabetes, cardiovascular disease, depression, food

choices and labels, and finally trustful website links.

Before ending the consultation, the CDE review with Ms. Brown all the subjects covered

during the section by requesting Ms. Brown to explain what they have spoken; this will insure

patient understanding. Provide Ms. Brown with all future schedule appointments, and finally

reinforce by telling her that if she has any further question a clinic case manage will be able to

assist during clinic working hours.

The nurse finalize her notes to make possible for the next RN caring for Ms. Brown to be

able to identify and reinforce working adaptive mechanisms, to identify new internal and

external stimuli, and identify coping mechanisms needing adaptation.


Conclusion

Sr. Callista Roy Adaptive Model has been proving effective in all patient care settings,

from intensive care units to home health care. RAM dynamic contour has the capability to assist

patient, family, community, and any others social groups towards a mutual learning,

understanding, and supporting patient and nursing wellbeing. Moreover help nursing staff to

develop their only personal coping mechanism when dealing with negative stimuli, as well

helping them to realize their own potential.

RAM was used with Ms. Brown to assist her understand her physical health and coping

mechanism in use, identify external stimuli, provide inside in how to cope with old stimuli in her

new life cycle, and also identify new stimuli. It will assist Ms. Brown to stay whole as an

individual in her surrounds and an integrated part of the collective.

We do understand that every second stimuli change and or a new stimuli is introduce, and

coping mechanisms are continuous process of body, mind and soul doing what nature does best

maintain homeostasis continually trying to stay / be one with God.


References

Alexander, M. F., Fawcett, J. N., & Runciman, P. J.. 2006. Roy’s adaptation model. In Nursing

practice: hospital and home: the adult (3rd ed.). pg. 1085. China: Elsevier Health

Sciences.

Andrews, H., & Roy, C. (1991). The Adaptation Model. Norwalk, CT: Appleton & Lange.

Hwoschinsky, C.. (2002). Listening with the heart (3rd ed.). Indianola, WA:

Compassionate Listening Project.

Manriquez, D. J. S.. (2001). Sister Callisto Roy theory on adaptation [PowerPoint slides].

Retrieved on 01/26/2012 from http://www.slideshare.net/davejaymanriquez/callista-roy-

presentation

Phillips, K. D. (2002). Roy’s adaptation model in nursing practice. Nursing theory: Utilization

& application (pp. 289-314). St. Louis: Mosby.

Phillips, K. D.. 2010. Sister Callista Roy: Adaptation model. Nursing theorists and their work

(7th ed). pg. 342. Mosby, Maryland Heights, MO.

Roy Adaptation Association. 2010. Boston College. Retrieved on 01/14/2012 from

http://www.bc.edu/schools/son/faculty/featured/theorist/Roy_Adaptation_Association.ht

ml

Roy, C.. 1997. Future of the Roy model: Challenge to redefine adaptation. Nursing Science

Quarterly, 10 (1), 44 - 46. doi:10.1177/089431849701000113

Roy, C., & Andrews, H. (1999). The Roy Adaptation Model. Stamford, CT: Appleton & Lange.

Roy, C.. 2009. The Roy adaptation model. 3rd ed. Pearson. Upper Saddle River, NJ.

Senasec, P. (2010). Implementing the Roy adaptation model: from theory to practice. Boston

College. Retrieved on 01/26/ 2012 from


http://www.bc.edu/schools/son/faculty/featured/theorist/Roy_Adaptation_Model/

Practice.html


Appendix

Case Study 4

Ms. Shanell Brown is a 45-year-old African American woman diagnosed with type 2

diabetes 4 years ago. She is being seen today by the RN Certified Diabetic Educator (CDE) for

evaluation on how she is managing her diabetes. Ms. Brown is a new patient, having recently

moved to the area. An initial review of her electronic health record indicates that she has a family

history of type 2 diabetes and cardiovascular disease. Ms. Brown was recently divorced and is

now a single mother with two children, a son age eight, and a daughter who is five. She recently

moved to a new apartment so they could be close to her mother who also lives in the same

complex. Her mother provides after school care for her children.

During the interview with the CDE, Ms. Brown states, “I haven’t been able to lose the

weight I gained during pregnancy with both my kids”. She leads a sedentary lifestyle mainly due

to her work as an administrative assistant for a local university. “I wish I had more time to

exercise but by the time I get home and take care of the children, there just doesn’t seem to be

any time left for me.” She was also diagnosed with mild hypertension and dyslipidemia during

this past year, which is something that is expected with type 2 diabetes. Ms. Brown confides she

feels well except for frequent tiredness and some paresthesias in her lower extremities, mainly

burning sensations that come and go in her calf muscles and the top of her feet.

Other information noted in her record show her blood pressure is under good control with

medication. She has a body mass index (BMI) of 30 kg/m², which is obese. Her waist

circumference is 40 inches. Her fasting glucose levels average between 140 and 160 mg/dl. Her

most recent A1C level is at 7.3%. The goal for the visit today is to help Ms. Brown understand


the importance of diet and exercise in controlling the progression of diabetes. Other factors that

may be considered are stress related to changes in her family situation.


Theory Paper Point Assignment

STUDENT NAME:

Criteria Points

Earned

Thoughts are expressed clearly and concisely using correct sentence structure 3Paragraphs are organized with an introductory sentence, discussion sentences and transition sentence to the next section 2Paper is organized with an introduction, discussion (with headings), and summary/conclusion 3Grammar and spelling errors are limited to less than 3 per document

2Paper correctly conforms to the latest edition of APA format:

Title page1

Double spacing1

Running head and pagination1

Citing sources within paper1

Reference list (matches citations in paper)1

Paper reflects integration of thoughts, feelings, beliefs, and values2

Paper reflects the ability of the student to think, analyze, and synthesize complex information from a variety of sources 3Total Points

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