ROY'S ADAPTATION MODEL FOR NURSING
Robert W. Stein, III, RN, MSHA, CHE, LNC
Roy (1970, 1971, 1976) described a model for nursing based on the concept of adaptation.
There are five major concepts of nursing explicated in her model: the person, the goal of nursing, nursing activities,
health, and the environment. These concepts are interrelated to the concept of adaptation. The person is viewed
as having four different modes of adaptation: physiologic, self-concept, role function, and interdependence modes.
Roy's model is concerned with the internal and external environmental stimuli affecting the development and behavior
of the person. The level of adaptation of the person is assessed and ways to remove the stimuli, to enhance, or
to maintain adaptation are explored by the person and the nurse. Roy's model is written referring to the person
as an individual client, however, her model can easily be applied to family groups or communities as well.
Sister Callista Roy was born in 1939 in southern California. She first learned about the
adaptation concept in a psychology class while doing graduate work at the University of California in 1964. Roy's
Adaptation Model began when she was challenged to develop a conceptual framework for nursing by Dorothy E. Johnson
during a seminar at the university. Sister Roy felt that this adaptation concept was an appropriate basis for a
conceptual framework in nursing. Roy's Adaptation Model was first put to use when the faculty at Mount Saint Mary's
in Los Angeles unanimously accepted it as the philosophical basis of the baccalaureate nursing curriculum in 1968
(Galbreath, 1985; Bonkoski, 1986).
Sister Roy first published her conceptual model in a 1970 Nursing Outlook article titled, "Adaptation:
A Conceptual Framework for Nursing". She has authored and co-authored several books explaining and expanding
her model. Among her writings are:
Conceptual Models for Nursing Practice (1974), Introduction
to Nursing: An Adaptation Model (1976, 1984), and Theory
Construction in Nursing: An Adaptation Model (1981).
In Roy's Adaptation Model (1970, 1976), the person is described as a bio-psycho-social being
in constant interaction with a changing environment and having four modes of adaptation: physiologic, self concept,
function, and interdependence. As internal and external environmental changes (stimuli) occur, the persons needs
change resulting in deficits and excesses. To protect his physiologic, psychic, and social integrity the person
adapts using coping mechanisms to restore need satisfaction. Roy describes the person as having a zone surrounding
his variable level of adaptation. Stimuli that fall within this zone will result in a positive response or adaptation.
Stimuli which falls outside of this zone will result in a negative response or maladaptation.
Two mechanisms of coping identified by Roy (1976) are the cognator and the regulator. The
cognator controls processes related to perception, learning, judgement, and emotion. The regulator functions primarily
through the use of the autonomic nervous system in making physiologic adjustments. In responding to the changing
environment, internal and/or external, the person uses the cognator and regulator mechanisms individually and together
to adapt, protecting his integrity. The resulting behavior is adaptive if a positive result occurs maintaining
the integrity of the person. A maladaptive behavior is a negative response that does not maintain the integrity
of the person.
Roy (1976) describes the environment as being both internal and external in relation to the
person - system. It is in a state of constant change and in a dynamic relationship with the person. Stimuli from
the environments affect the development and behavior of the person threatening his integrity.
Roy (1976) describes health as being a state of successful positive adaptation to stimuli
from the environment interfering with basic need satisfaction and threatening to disrupt the system equilibrium.
A healthy person is one whose integrity has been protected as a result of his ability to adapt. Illness therefore,
is a state of threatened integrity as a result of an inability to adapt or maladaptive responses to stimuli.
The goal of nursing, in Roy's model is to promote positive adaptation in each of the four
adaptive modes of the person. Nursing is also concerned with illness prevention and health maintenance by widening
the person's zone of adaptation (Roy, 1970, 1971, 1976).
The nursing process, as defined in Roy1s Adaptation Model consists of six steps: First level assessment, Second level assessment, Problem
Identification, Goal Setting, Intervention, and Evaluation (Roy, 1976).
First level assessment - the assessment of client behaviors -is the evaluation of the persons
behavior in each of the four adaptive modes: physiologic, self-concept, role function, and interdependence. The
nurse then selects areas of concern, either maladaptive behaviors or adaptive behaviors requiring reinforcement.
These areas of concern are then taken into Second level assessment (Roy, 1976).
In Second level assessment - the assessment of influencing factors - the nurse takes the
behaviors of concern and further evaluates the determining the focal, contextual, and residual stimuli contributing
to them. The focal stimuli are the extent or degree of change immediately confronting the person. The contextual
stimuli are all other stimuli affecting the person presently. Residual stimuli consist of the beliefs, attitudes,
and experiences that color his reactions to the focal stimuli. Assessment of the focal, contextual, and residual
stimuli will allow for an individualized nursing diagnosis, behavioral goals, and nursing actions for the person
(Roy, 1976).
Problem identification or nursing diagnosis is a prioritized list of short summary statements
of the persons problems evaluated in the second level assessment. As previously stated, the nursing diagnosis is
related to the four adaptive modes. Roy offers her own typology of nursing diagnosis, however, she feels that using
statements of behavior and influencing factors may be more productive until nursing has a standardized nomenclature
(Roy, 1976).
Goal setting is a cooperative effort between the nurse and the person whenever possible.
Generally, the nursing goal is to change maladaptive behaviors, reinforce adaptive behaviors and to enhance the
person's coping abilities. Nursing goals should always be stated in terms of behavioral outcomes for the person
(Roy, 1976).
Intervention can take place by two different approaches or both approaches combined. In the
first approach, the nurse manipulates the focal stimuli to allow for a positive adaptive response. The second approach
is to widen the persons zone of adaptation so that the stimuli falls within the persons ability to adapt positively.
The consequences of each manipulation are evaluated and the one with the highest probability of a positive response
and lowest probability of an undesired outcome are selected (Roy, 1970, 1976).
Evaluation is the final step in the nursing process. The effectiveness of the nursing action
is determined by the assessment of the persons' outcome behaviors. If the outcome behaviors are the same as the
stated goals, then the intervention has been successful. If the outcome behaviors are still maladaptive, further
evaluation of the nursing action needs to take place for consideration of a different approach. Once adaptive behaviors
are developed, the nursing process is started over to evaluate any new or on-going problems. As a result, the nursing
process is cyclical in nature (Roy, 1976).
Roy's Adaptation Model for nursing is based on the concepts of the person adapting to his
changing environment. The role of nursing in the model is to facilitate the person in this adaptation protecting
the persons' integrity. The model can be applied to the individual client, the family group, or the community (Roy,
1976).
Roy's model, being prescriptive in nature, is concerned with the values, goals, patiency
of the recipient, and intervention. Sister Roy feels that she has addressed these criteria, however,	states
there is a need for continued testing for further validation and development of her model (Wagner, 1976; Stevens,
1979).
Roy's model provides complete descriptions of all four essential concepts of nursing in her
more recent writings on the model. Man, health, environment, and nursing are well defined in her book Introduction to Nursing: An Adaptation Model (1976) (Galbreath, 1985).
Earlier articles were somewhat vague and contained discrepancies between writings, possibly reflecting the growth
and development of the model (Wagner, 1976).
In Roy's Adaptation Model the basic assumptions link the concepts of man, environment, health,
and nursing together completely. The eight assumptions support and clarify Roy's definitions of the four concepts
and help to show how they are interrelated (Bonkoski, 1986).
The internal structure of the model is logically consistent. Interrelationships are sequential,
follow the principles of reasoning, and are related back to the underlying concepts. It was noted, however, that
while Roy states the model can be applied to an individual, a family group, or to a community all examples included
are applied to the person. Additional examples relating the model to family groups and community health care would
further clarify these uses (Galbreath, 1985).
Roy's Adaptation Model is presented by a logistic method. The whole is organized by the reference
to its parts and their relationships to each other. Roy's model is also considered a systems model, an interactionist
model, and an adaptation model. Its characteristics are consistent with other models of these types, but so as
to provide a new perspective (Stevens, 1979; Fawcett, 1983; Galbreath, 1985).
The Adaptation Model by Roy is parsimonious. It is simple enough to understand and generalizable
enough to be applied to practice, research, and education (Galbreath, 1985). It has been used in a variety of clinical
areas including both inpatient and outpatient settings. The model has been used in research in a variety of settings.
It is useful in school curriculums, getting its start as the basis of the baccalaureate nursing
program at Mount Saint Mary's, Los Angeles (Wagner, 1976; Bonkoski, 1986).
	Testable theories can be, and have been generated from the Adaptation Model. There
are many testable aspects to the model. Roy and others have encouraged testing to validate the model and to generate
nursing knowledge as a science (Wagner, 1976; Hammond, Roberts, & Silva, 1983).
Hammond, Roberts, & Silva (1983), to further nursing science tested two groups of nurses,
one using first and second level assessment and the other using first level assessment alone. Their results demonstrated
no significant difference in reaching accurate nursing diagnosis between the two groups. The importance of the
study, they state, is not in their results, but in demonstrating that nursing models can provide researchable questions,
be tested, and then be presented as nursing science.
Roy's model contributes to nursing in the areas of practice, research, education, and the
development of nursing science. The model provides a new way of looking at the person in the providing nursing
care. The model has given nursing educators a conceptual framework for their curriculums. Research is contributed
to in that there are many questions that can be deduced from the model. The development of nursing science benefits
from the research expanding our body of nursing knowledge (Wagner, 1976; Hammond, Roberts, & Silva, 1983).
In summary, Roy's model is concerned with a persons adaptive response to environmental stimuli.
Environmental stimuli may be either internal or external to the person, and may or may not fall within his zone
of adaptation. The plan of nursing actions is to assist the person in adapting to environmental stimuli through
the physiologic, self-concept, role function, and interdependence modes. The goal of nursing actions is to promote
adaptive responses and change maladaptive responses to adaptive ones (Roy, 1970, 1971, 1976). The model fulfills
the criteria of a nursing theory and is useful in nursing practice, research, education, and in the development
of nursing science. It has evolved since it's beginning becoming more defined. There remains a need for continued
research to further clarify and define the model and to further nursing science (Galbreath, 1985).
REFERENCE LIST
- Camooso, C, Greene M., & Reilly, P. (1981). Student's Adaptation According to
Roy. Nursing Outlook, 31(2), 108-109.
- Bonkoski, J.I. (1986). Sister Callista Roy's Adaptation Theory. Unpublished manuscript, Georgetown University.
Washington, D.C.
- Fawcett, J. (1983). Hallmarks of Success in Nursing Development. In P. L. Chinn (ED.), Advances in Nursing Theory Development (pp. 3 - 17). Rockville, Maryland:
Aspen Publication.
- Hammond, H., Roberts, M.P., & Silva, M.C. (1983). The Effect of Roy's First Level and
Second Level Assessment on Nurse’s Determination of Accurate Nursing Diagnosis. Virginia
Nurse, 2, 14
- Galbreath, J.G. (1985). Sister Callista Roy. In J.B. George (Ed.) Nursing
Theories: The Base for Professional Nursing Practice. (pp. 300 - 318).
- Roy, C. (1970). Adaptation: A Conceptual Framework for Nursing. Nursing
Outlook, 18(3), 42 - 45.
- Roy, C. (1971). Adaptation: A Basis for Nursing Practice. Nursing
Outlook, 19(4), 254 - 257.
- Roy, C. (1976). Introduction to Nursing: An Adaptation Model. New Jersey: Prentice - Hall.
- Stevens, B.J. (1979). Nursing Theory: Analysis, Application,
Evaluation. Boston: Little, Brown and Company.
- Wagner, P. (1976). The Roy Adaptation Model: Testing the Adaptation Model in Practice. Nursing Outlook,
24(11), 682 - 685.
