Roy's Adaptation Theory

Details of Roy's Adaptation Theory.

1. ROY ADAPTATION THEORY PRESENTED BY: RITTIKA DAS NEOGI 1STYEAR M.SC NURSING

2. ‘Adaptation is viewed as the process and outcome whereby thinking and feeling persons as individuals or in groups, use conscious awareness and choice to create human and environmental integration.’ Sister Calista Roy.

3. About the Theorist Sister Callista Roy is a nursing theorist, professor and author. She was born on October 14, 1939 at Los Angeles, California. She majored in nursing in 1963 from Mount Saint Mary's College, Los Angeles.  She received Master's Science in Pediatric Nursing from University of California. She was a postdoctoral scholar in Neuroscience Nursing at University of California.

4. About the Theorist Worked as a Pediatric Nurse, Nursing Instructor and in many different capacities. She was Professor and Nurse Theorist at the Boston College of Nursing. Dorothy E. Johnson mentored her to develop this adaptation model while pursuing her Master's Degree.  Roy's Adaptation Model was implemented in Mount Saint Mary's School in 1970. The Roy Adaptation Model was first published in Nursing Outlook in 1970 entitled “Adaptation : A Conceptual Framework for Nursing ”.

5. About the Theorist At present, she is a P rofessor at School of Nursing at Boston. She has many Honorary Doctorate Degrees and awards in excellence in fostering professional nursing standards. Sister Callista Roy has also been recognized as a living legend in 2007 by American Academy of Nursing.

6. Theoretical Sources Roy credits Harry Helson’s Adaptation Theory (1947) for playing a key role in her early thinking and development of the model. She credits Rapoport’s Definition of systems as well as concepts regarding Theory of stress from Lazarus and Selye (1984). Roy acknowledges the contribution made by other faculty and students to the development of the model.

7. SCIENTIFIC   Consciousness is constructed of individual and environment integration.   Awareness of self and environment is rooted in thinking and feeling.    Thinking and feeling mediate through human actions.   R elationships include acceptance, protection, and fostering of interdependence.     Integration of human being and environment results in Adaptation.  

8. PHILOSOPHICAL   Individual has mutual relationships with the world and God.     God is revealed in the diversity of creation Individual use human creative abilities of awareness, enlightenment, and faith.   Individual are accountable for the processes of deriving, sustaining, and transforming the universe.

9. CULTURAL   Experience within a specific culture will influence how each element of the Model is expressed. Within a culture, central culture will influence the elements of the Roy Adaptation.   Cultural expressions of the elements of Model may lead to changes in practice activities like nursing assessment. Due to multi-cultural perspective, implication and research may differ from the experience in the original culture

10. Statement of the Theory “The goal of nursing is to promote adaptation for individuals and groups in each of the four adaptive modes; i.e. physiological needs, self-concepts, role function and interdependent relations, thus, contributing to health quality of life and dying with dignity.”

11. PERSON Human beings are in constant interaction with their environment which brings both internal and external changes. They respond to the environmental stimuli they experience. The characteristic of openness in human allows a person to adapt in constantly changing environment. Human is as an adaptive system.

12. ENVIRONMENT According to Roy, environment means " The conditions, & circumstances affecting the development and behavior of persons ”. A person exists in an open relationship with the environment. T he internal and external stimuli affect the person.

13. NURSING The goal of nursing is the promotion of adaptation for human beings by four adaptive modes leading to health, quality of life and dying with dignity.  Nurses assess the client's behaviors, promote positive adaptation by enhancing environment interactions and helps clients react positively to stimuli . Nurses  eliminate ineffective coping mechanisms . L eads to better outcomes for the clients.

14. HEALTH Roy defines health as, “ A state or process of being or becoming an integrated and whole person .” Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to cope with them. If human being can adapt holistically, they will be able to maintain health to reach completeness . If persons cannot adapt, the integrity of the person is affected negatively .  Health is the state where human can adapt to stimuli.

15. Major Concepts of Roy's Adaptation Model System: P arts which are interconnected and interdependent to form a unity. The system is characterized by inputs, outputs, control and feedback processes. Adaptation: Adaptation is the process and outcome where by thinking and feeling individuals or groups use conscious awareness and choice to create human - environmental integration. Adaptation problems: Adaptation problem means the occurrence of a state due to inadequate responses to meet deficit.

16. Major Concepts of Roy's Adaptation Model Stimuli: A person’s adaptation is influenced by stimuli from the environment. C ategories Focal stimuli: T he internal or external stimuli which immediately confront the individual’s awareness and consciousness.   Contextual stimuli: Contextual stimuli are all other stimuli that contribute to the effect of the focal stimuli. S timuli influence how people deal with the focal stimuli.   Residual stimuli: Residual stimuli are environmental factors within or outside the human system. These factors though effect on behavior.

17. Major Concepts of Roy's Adaptation Model Coping Processes: It includes both innate and acquired coping mechanism. Innate mechanisms are inborn, genetically determined, common to the species and are automatic process . Acquired coping are learned or developed responses.   The process of coping is further categorized by Roy as “The Regulator & Cognator Subsystems are applied to individuals; whereas Stabilizer and Innovator Subsystems are applied to groups”.

18. Major Concepts of Roy's Adaptation Model Levels of Adaptation: Adaptation level of an individual represents the condition of life process. Integrated process: The modes and subsystems meet the needs  of the environment forming a stable process (e.g. spiritual realization, breathing, successful relationship). Compensatory process: The cognator and regulator are challenged by the needs of the environment, but trying to meet the needs (e.g. starting with a new job, grief, compensatory breathing).   Compromised process: The various modes and subsystems are not sufficiently meeting the environmental challenge (e.g. unresolved loss, hypoxia, abusive relationships).

19. Major Concepts of Roy's Adaptation Model Levels of Adaptation Integrated to Compensatory An integrated life process may change to compensatory process where attempt is made to re-establish adaptation. Compensatory to Compromised If the compensatory process are not adequate then result is compromised.

20. Major Concepts of Roy's Adaptation Model Internal processes or Subsystem   Regulator: It is P hysiological C oping  M echanism of an individual through which the body attempts to cope through N eural, Chemical and Endocrine coping channels. Stimuli from environment act as inputs through the senses to the nervous system. It affects the fluid, electrolyte, acid-base balance and endocrine system. This information is all channeled automatically. T he body produces an Automatic – Unconscious R esponse to it.

21. Major Concepts of Roy's Adaptation Model Internal processes or Subsystem   Cognator: M ajor coping process for individuals . It involves 4 Cognitive-Emotive C hannels: a) Perceptual & Information processing: It includes activities of selective attention, coding and memory. b) Learning: It includes imitation, reinforcement and insight. c) Judgement: It includes problem solving and decision making. d) Emotion: It includes effective appraisal and attachment.

22. Major Concepts of Roy's Adaptation Model Adaptive Modes: Through the adaptive modes the responses to & interaction with the environment can be carried out and adaptation can be observed . There are 4 adaptive modes: Physiologic – Physical Mode Self-concept – Group-identity Mode The Role Function Mode The Interdependence Mode

23. Physiologic Physical Mode   It is the M anifestation of Physiologic A ctivities of all cells, tissues, organs and systems that make up the body. It includes 5 basic needs of: Oxygenation: Patterns of oxygen use related to respiratory and cardiovascular physiology and pathophysiology.  Nutrition: Patterns of nutrient used to maintain effective human functioning and how the nutrient help for growth and repairing injured tissue. Elimination: Patterns of elimination of waste products .  Activity & Rest: How the pattern of activity and rest takes place in an individual. Protection: Skin integrity and immunity .

24. Physiologic Physical Mode   In addition, four processes are involved in Physiologic Adaptation : a) Senses: Sensory-perceptual information b) Fluid, Electrolyte, Acid-Base Balance: How the fluid and electrolyte balance  maintained in the body.  c) Neurologic Functions: Relationship of neural function to regulator and cognator coping mechanism d) Endocrine Functions: How the endocrine system act in conjunction with nervous system to maintain control of the body process.  

25. Self-concept - Group-identity mode The basic need underlying the self-concept mode is psychic and spiritual integrity that is the need to know who one is so that one can exhibit a sense of unity . This mode includes : Physical self (body sensation & body image) Personal Self (self-consistency, self- ideal & the moral ethical- spiritual self)

26. Self-concept - Group-identity mode Body Sensation: How the individual experiences the physical self.   Body image: How the individual views the physical self.   Self-consistency: Individual’s efforts to maintain self-organization. Self-ideal or expectancy: Represents what the individual expects to be and to do.   Moral-ethical-spiritual self: Represents individual’s belief system and self- evaluation.

27. Role Function M ode   It focuses on the role of the person in the society and group within. The basic underlying need is S ocial I ntegrity . It includes:   Primary role: It determines the majority of individual's behaviors and is defined by the individual's sex, age, and developmental stages. Secondary role : It includes to carry out the tasks required by the stages of development and primary role.    Tertiary role: These roles are temporary, feely chosen, and may include activities related to hobbies.  

28. Interdependence Mode It includes behaviour towards interdependent relationships like giving and receiving of love, respect and value. The basic underlying need is relational integrity and feeling of security in the interdependent relationship. It includes 2 specific relationships: Relationship with significant others Relationship with support systems

29. Propositions of Roy Adaptation Model Stimuli from internal and external environment serves as inputs to the nervous system which produces automatic unconscious response. Stimuli and adaptation level serve as input to human adaptive systems . One must make adaptations to accommodate new environmental requirements. The internal and external stimuli influence behavioural responses. Human beings are described as adaptive systems that are constantly growing and developing within changing environments.

30. Propositions of Roy Adaptation Model Health for human adaptive systems are reflections of adaptation . The Goal of Nursing is the promotion of adaptation there by contributing to health, quality of life, dying with dignity. N ursing intervention is to maintain the adaptive behaviour and to change ineffective behaviour to adaptive. Nurse’s role is to promote adaptation in health and illness by enhancing the interaction of human systems with the environment.

31. Application of the Theory Nursing Practice The Roy adaptation model is one of most frequently used conceptual frameworks used to guide nursing practice. Senesce (2003): This model can be used by individual nurse to understand, plan and direct nursing practice in the care of individual patients. Villarreal (2003): applied this model in caring of young women who were contemplating smoking cessation.  Newman (1997): used the model to caregivers of chronically ill family members. 

32. Application of the Theory Nursing Education Roy suggests this model helps to clarify objectives, identifies content and specifies patterns for teaching and learning.  This model provides nursing educators a systemic way of teaching students to assess and care for patients within the context of their lives  rather than just as victims of illness.  In the early 1980's the School of Nursing at the University of Ottawa experienced a major curriculum change by incorporating this  model as base to their new curriculum.

33. Application of the Theory Nursing Research This model is used in knowledge development . Young-McCaughan (2003) by using Roy's Adaptation Model studied  the effect of a structured aerobic exercise tolerance, sleep patterns and quality of life in patients with cancer. Bournaki (1997) by using Roy's adaptation model studied Pain related responses to venipuncture in school-age children. 

34. Nursing Process and the Roy Adaptation Model Roy specifically stresses that the nursing process is ongoing and continuous. Roy states regarding nursing process that ‘ Nurses rely on intuitive skills to assess and initiate interventions.” A nurse's role in the Adaptation Model is to manipulate stimuli by removing decreasing, increasing or altering stimuli so that the patient can adapt effectively.   

35. Assessment   Assessment of behaviour Nurse must identify the behaviours hinder adaptive process. In the First Level Assessment , the nurse assesses the behaviors manifested from the four adaptive modes. The nurse uses observational skills, intuition, accurate measures and interviewing skills to systematically gather data. In the Second Level Assessment , the nurse assesses the stimuli; categorize them as focal, contextual, or residual leading to identification of internal and external stimuli which influences individual's adaptive behaviors.

36. Nursing Diagnosis Analysis of data of both levels of assessment results in formulation of a nursing diagnosis that reflects the patient’s adaptive state. Goal Setting It involves clear statement of the behavioural outcomes of nursing care. The goal is to promote client's adaptation process through nursing care. Roy also suggests to provide time frame in which the goal is to be attained.

37. Implementation T he nurse chooses interventions to promote the desired adaptation through either changing stimuli or strengthening adaptive process. The nurse and patient in collaboration identifies the desirable or undesirable consequences. Once the appropriate nursing intervention has been selected, the nurse initiate steps that will enhance coping.  

38. Evaluation   Evaluation focuses on judging the effectiveness of the nursing intervention in relation to the behaviour of the individual. To determine if the adaptive goals have been met, the nurse uses the same skills as were employed in the assessment phase of the process – observation, intuition, measurement and interviewing.  

39. Clinical Application of the Theory Mr . Kumar, a 58 years old patient has been admitted to the hospital with complaints of non-healing wound in his right leg since 6 weeks. He is a known case of Diabetes Mellitus since last 12 years and has been on insulin regimen. He was admitted after various ineffective treatment for the non-healing wound. He works in bank and is the sole earning member of the family of 6. On admission he has been planned for amputation of toes of right leg and a long hospital stay .

40. Clinical Application of the Theory Demographic Date of the Client   Name : Mr. Kumar Age : 58 years Sex : Male IP number : M2863 Education : Post graduate Occupation : Bank officer Marital status : Married Religion : Hindu Informants : Client and Wife Date of admission : 04/04/2015 Diagnosis : Diabetes mellitus

41. First Level Assessment   Physiologic-Physical Mode Oxygenation  His capillary refill time delayed and Dorsalis pedis pulsation of affected limp is not palpable.  Nutrition: On diabetic diet, complaints of anorexia since admission. Elimination: He complaints of constipation since 3 days. Activity: Activity reduced now due to wound in right leg, walking with the help of crutches , complaints of pain , needs assistance in activities.      

42. First Level Assessment   Physiologic-Physical Mode Senses: Because of neuropathy, he has reduced touch and pain sensation in the lower periphery. Fluids and Electrolytes:  Serum electrolyte values are within normal limit, RBS is 300 mg/dl . Neurological Function: - He is very anxious about the disease condition and his family’s future. Endocrine function: - Due to DM he is on insulin since 9 years.       

43. First Level Assessment Self- Concept Mode Physical Self  - He is very anxious about body image changes , but he is accepting treatment and trying to cope with the situation.  Personal Self: - Because of financial burden and hospitalization, self-esteem disturbed .  Role Performance Mode  - He was the only earning member in his family. His role shift is not compensated. Interdependence Mode  - Maintains good relationship with the family, neighbors, friends and relatives.       

44. Second Level Assessment   Focal Stimulus Non-healing wound leading to amputation, which is the cause of hospitalization. Repeated hospital stay. Suffering from non-healing wound since considerable period. Ineffective treatment regimen .      

45. Second Level Assessment   Contextual Stimuli He is a known case diabetes mellitus for past 12 years. He is not in habit of wearing footwear in house and premises.   Residual Stimuli  - He suffered from Tuberculosis 5 years back. His mother was diabetic. He is a graduate in economies, so no special knowledge regarding health matters.       

46. Nursing Process ASSESSMENT NURSING DIAGNOSIS GOAL PLANNED INTERVENTION EVALUATION Focal Stimuli: Alteration in Physical self of self control mode due to change in body image. Contextual Stimuli: He is a known case of DM. He is aware of the planned reconstructive surgery. Residual Stimuli: As a student of economics, he possesses limited health related knowledge. Anxiety related to change in body image, hospital admission, unknown outcome of the disease and financial constraints as evidenced by complaints of insomnia, vocalization and facial expressions of the patient. To reduce anxiety. - Allow and encourage him to ask questions. - Allow him and to verbalize their anxiety. - Provide comfortable and quiet environment for the patient. - Possible increased interaction with family. - Identify his stressbuster and allow such activity. Music Therapy. Coping through Cognator Subsystem Goal Met: - Able to take rest, uninterrupted sleep for considerable time. -Asking less question. Looking less stressed. Unmet: - He is not totally free from anxiety due to financial constraints. -Continue plan, re-evaluate goal and interventions.

47. Critique of the Theory Clarity: The concept is logical, but the development of definitions are inadequate .  Simplicity: It is complex due to several major concepts, sub concepts. Generality: It is generalizable to all settings in nursing practice. It addresses the concept of person-environment adaptation and focuses primarily on the client.   Empirical precision: Testable hypothesis.  Derivable consequences : It has a clearly defined nursing process which is useful in clinical practice. It generates new information through hypothesis testing.  

48. Limitation Theory is very conceptual. I t is difficult to understand. Four adaptive modes have unclear boundaries . 

49. Assignment