Sister Callista Roy:Adaptation Model

Jill N Meyokovich, RN BSN

Sister Callista Roy

Born 1939-presentMember of the Sisters of Saint Joseph of

CarondeletBSN, MSN, Masters and Doctorate of

SociologyProfessor, clinical nurse scholar, nurse

theorist, author

Becoming of the Model

While working on masters, was mentored by Dorothy Johnson

Challenged to develop a conceptual model

Roy noticed the resiliency of children and change

Intrigued by adaptation becoming the eventual framework

Becoming of the Model cont

1968: Operationalization1970: Literature debut1977: Model presentation

Basis of Adaptation Model

Harry HelsonRapoport definition

◦Combination became definition of a person as an adaptive system

Dohrenwend, Lazarus, Mechanic, and Selye

Biological, and behavioral sciencesUnderpinnings Johnson’s behavioral

model

Statement of theory

“The goal of nursing is to promote adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health quality of life, and dignity with dying” (Roy 1999, p. 19)

Main premise of theory

“When push comes to a shove, we will seldom disappoint ourselves. We all harbour greater stores of strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which we are made.Do not underestimate the power of a person to cope. He may be dependent now but deep within him lies the energy to adapt”

http://nursingtheories.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html

My view of the RAM

I believe the adaptation model as a framework used to see a person who is constantly influenced by their environment; people have the chance to positively respond to their environment and adapt, or fail at adapting. It is the nurse who guides us in the succession of adaptation.

Metaparadigm

PersonEnvironmentHealthNursing

Terms

EnvironmentStimuliHealthAdaptationIneffective responsesAdaptation levelNursing

Key points

Key focus is adaptationPerson is an adaptive system affected by

stimuli◦Stimuli can be internal or external• Positive outcome to stimuli allows adaptation◦Negative outcome/ineffective responses to

stimuli alert the need for nursing intervention

Assumptions

Major assumptions◦ Scientific◦ Philosophical◦ Implicit

HumanismVeritivity

Propositions

Nursing promotes adaptive responsesNursing decreases ineffective responsesNursing enhances interaction which

promotes adaptation

Main concepts

Two internal mechanisms for adaptation◦ Regulator◦ Cognator

Four adaptive modes◦ physiological-physical needs◦ self concept group identity◦ role function◦ interdependence

4 modes

PhysiologicalSelf-concept/group identityRole functionInterdependence

Diagram RAM

Nursing Implications

Goal is directed to establishing adaptation

Contribute to health, quality of life and dying with dignity

Roy Adaptation Model Nursing Process◦ Assessment of behavior◦ Assessment of stimuli◦ Nursing diagnosis◦ Goal setting◦ Nursing intervention◦ Evaluation

Internal criticism

AdequacyClarityConsistencyLogical DevelopmentLevel of Theory Development

External Criticism

ComplexityDiscriminationReality ConvergencePragmaticScopeSignificanceUtility

Tools/Instruments

Used to measure perceptions of powerlessness in decision making

Health care outcomes for cancer patientsFramework for adult survivors of multiple

traumasDescribe relationship between nursing

intervention and interpretation of resultsUsed as a basis for checklist for problematic

behavior prediction

Application of theory to practice

Middle range theory areas◦ Caregiver well being◦ Coping with pain ◦ Coping with chronicity

This is not the first situation that came to mind as I was reflecting this question, but this is the most appropriate situation, I believe for this exercise. There was a woman in her 40s who presented to the ED with a c/c of assault. She was pregnant, had been vomiting, and was assumed to have taken some type of psychoactive medication due to her erratic behavior. She was uncooperative with her nurse and was yelling, crying, refusing to take her medication, and refusing a urine specimen. After about one hour of trying to coerce compliance with the woman, my colleague desperately came to me and asked if I could “try to talk some sense into this lady”. “Therapeutic communication is not my strong point Marian, you know that”, was my response. However, we have a very tight nit bond of nurses in our department, and I felt my obligation to help. I proceeded into the room with a plan to place myself in an inferior position as to elicit a feeling of safety and comfort. I said nothing as I entered the room and immediately turned the lights taking a blanket from the shelf for her. I sat down in the chair next to her and said absolutely nothing for what felt like an eternity. Finally, I asked her how I could help her. She did not respond and I sat there for yet another eternity. When I stood up to walk out she told me to sit back down. Finally she began to talk, and might I add, for a VERY long time agreeing to comply with the treatment plan. I was thoroughly convinced that I was not going to be able to help this woman, but I was determined to try. I believe that all patients, even the most difficult ones, want help. Some people have great difficulty relinquishing control and giving trust to others. Therefore, I believe that by turning the lights off, I created a safety ground for her because she did not have to look at me. With the blanket, I showed compassion and offered her comfort. With my silence, I offered a willingness to help without saying so. By sitting in the chair, I made myself an equal instead of a superior. This was one of “proud” moments in my nursing career. I touched someone that was untouchable by others. And my fellow nurses were so shocked when I came back to the nursing station with a urine specimen they thought I voided in the cup myself! Although this was a difficult situation for the both the patient and I, I would have wanted the nurse to treat my mother or my sister just as I had treated her. I slept quite well that night.

Practice reflection/problem

Practice reflection/problem

Moreno, M., Duran, M., & Hernandez, A. (2009). Nursing care for adaptation. Nursing science quarterly. Jan, 67-73.

Research articles

Wright, P., Holcombe, J., Foote, A., & Piazza, D (1993). The Roy adaptation model used as a guide for the nursing care of an 8 year old child with leukemia. Journal of Pediatric Oncology 10(2), 68-74.

Sercekus, P. & Mete, S. (2009). Effects of antenatal education on maternal prenatal and postpartum adaptation. Journal of Advanced Nursing Dec, 999-1010.

Conclusion

RAM is a complex theoryRAM lends many applications to

education and researchRAM theorizes that people are adaptive

systems constantly influenced by stimuliNursing is used to increase adaptive

behaviorsNursing is used to decrease maladaptive

behaviors

References

Alligood, M, & Tomey, A. (2010). Nursing theorists and their work: 7th ed. Maryland Heights MO: Mosby.

Meleis, A. (2007). Theoretical nursing:4th ed.. Philadelphia: Lippincott William & Wilkins.

Moreno, M, Duran, M, & Hernandez, A. (2009). Nursing care for adaptation. Nursing Science Quarterly, 22(1), 67-73.

Peterson, S, & Bredow, T. (2009). Middle range theories application to nursing research: 2nd ed. Philadelphia: Lippincott William & Wilkins.

Roy, C, & Andrews, H. (1999). Roy adaptation model. Stanford CT: Appleton & Lange. Roy, S.C. (1988). An Explication of the philosophical assumptions of the roy adaptation

model. Nursing Science Quarterly, 1(26), 26-34. Sercekus, P, & Mete, S. (2009). Effects of antenatal education on maternal prenatal

and postnatal adaptation. Journal of Advanced Nursing, Dec, 999-1010. Sister callista roy. (2008, July). Retrieved June 1, 2010 from

http://nursingtheories.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html Wright, P, Holcombe, J, Foote, A, & Piazza, D. (1993). The Roy adaptation model used

as a guide for the nursing care of an 8 year old child with leukemia. Journal of Pediatric Oncology Nursing, 10(2), 68-74.