The Roy Adaptation Model

History
The Roy Adaptation Model for Nursing had its beginning when Sr. Callista Roy entered
the masters program in pediatric nursing at University of California Los Angeles in 1964.
Her advisor and seminar faculty was Dorothy E. Johnson who was writing and speaking
on the need to define the goal of nursing as a way of focusing the development of
knowledge for practice. Dr. Roy had read a little about the concept of adaptation and was
impressed with the resiliency of children she had cared for in pediatrics. At the first
seminar in pediatric nursing, she proposed that the goal of nursing was promoting patient
adaptation. Throughout her course work in the master's program Dorothy Johnson
encouraged her to develop her concept of adaptation as a framework for nursing. The use
of systems theory as defined by von Bertalanffy was an important early concept of the
model, as was the work of Helson. Helson defined adaptation as a process of responding
positively to environmental changes and described three types of stimuli, focal,
contextual and residual. Dr. Roy made appropriate derivations of these concepts for use
in describing situations of people in health and illness. Other authors that influenced the
early development of the central concepts of the model included Dohrenwend, Lazarus,
Mechanic, and Selye. The view of the person as an adaptive system took shape from this
early work with the cognator and regulator being added as the major internal processes of
the adapting person.
The second phase of the development of the model was the 17 years of work with faculty
at Mount St. Mary's College in Los Angeles. The model became the framework for a
nursing-based integrated curriculum in March 1970, the same month that the first article
on the model was published in Nursing Outlook. The four adaptive modes were added as
the ways in which adaptation is manifested and thus as the basis for nursing assessment.
Specifically a content analysis was done on 500 samples of patient behavior from all
clinical areas, collected by the nursing students and major categories named as
physiologic, self concept, role function and interdependence. Contributors to the
theoretical development of the adaptive modes included: Marie Driever for self concept;
Brooke Randell for role function, and Joyce Van Landingham and Mary Tedrow for
interdependence. Marsha Sato helped identify both common and primary stimuli
affecting the adaptive modes and Joan Cho developed clinical tools for assessment. Many
other faculty from Mount St. Mary's College were involved in writing the first three
textbooks on the model in 1976, 1984 and 1991.
Through curriculum consultation throughout the USA and eventually worldwide, Dr. Roy
received input on the use of the model in education and practice. By 1987 at least
100,000 nurses had been educated in programs using the Roy Adaptation Model. As the
discipline of nursing grew in articulating its scientific and philosophical assumptions, Dr.
Roy also articulated her assumptions. Early descriptions included systems theory and
adaptation-level theory, as well as humanist values. Later Dr. Roy developed the
philosophical assumption of veritivity as a way of addressing the limitations she saw in
the relativistic philosophical basis of other conceptual approaches to nursing and a
limited view of secular humanism and published a major paper on her philosophical
assumptions in 1988.
By the late 1990s Dr. Roy felt on urgency to re-define adaptation for the 21st Century.
She drew upon expanded insights in relating spirituality and science to present a new
definition of adaptation and related scientific and philosophical assumptions. Her
philosophical stance articulates that nurses see persons as co-extensive with their physical
and social environments. Further, nurse scholars take a value-based stance and rooted in
beliefs and hopes about the human person, they develop a discipline that participates in
enhancing the well-being of persons and of the earth. Dr. Roy has used the term cosmic
unity to describe that persons and the earth have common patterns and mutuality of
relations and meaning and that persons through thinking and feeling capacities, rooted in
consciousness and meaning, are accountable for deriving, sustaining, and transforming
the universe. These ideas were explained in a 1997 publication and included in the 1999
revision of the theorist's textbook on the model.
Other major developments of the model in the 1999 textbook, written with Dr. Heather
Andrews, include: 1) expanding the adaptive modes to include relational persons as well
as individual persons and 2) describing adaptation on three levels of integrated life
processes, compensatory processes, and compromised processes. Dr. Roy has also
outlined a structure for nursing knowledge development based on the Roy Adaptation
Model and provided examples of research within this structure. Dr. Roy remains
committed to developing knowledge for nursing practice and continually updating the
Roy Model as a basis for this knowledge development.

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Overview
ASSUMPTIONS
Scientific

· Systems of matter and energy progress to higher levels of complex self-organization

· Consciousness and meaning are constitutive of person and environment integration
· Awareness of self and environment is rooted in thinking and feeling
· Humans by their decisions are accountable for the integration of creative processes
· Thinking and feeling mediate human action
· System relationships include acceptance, protection, and fostering of interdependence
· Persons and the earth have common patterns and integral relationships
· Persons and environment transformations are crated in human consciousness
· Integration of human and environment meanings results in adaptation
Philosophical

· Persons have mutual relationships with the world and God

· Human meaning is rooted in an omega point convergence of the universe
· God is intimately revealed in the diversity of creation and is the common destiny of
creation
· Persons use human creative abilities of awareness, enlightenment, and faith
· Persons are accountable for the processes of deriving, sustaining, and transforming the
universe
PERSONS AND RELATING PERSONS

· An adaptive system with coping processes

· Described as a whole comprised of parts
· Functions as a unity for some purpose
· Includes people as individuals or in groups (families, organizations, communities,
nations, and society as a whole)
· An adaptive system with cognator and regulator subsystems acting to maintain
adaptation in the four adaptive modes: physiologic-physical, self-concept-group identity,
role function, and interdependence
Adaptive Modes Individual Group
Five needs-oxygenation,
nutrition, elimination, activity
and rest, protection Operating resources:
Four complex processes- participants, capacities,
Physiologic-physical
senses; fluid, electrolyte, and physical facilities, and fiscal
acid-base balance; neurologic resources
function; endocrine function

Need is group identity

integrity through shared
Need is psychic and spiritual
relations, goals, values, and
integrity so that one can be or
Self-concept-group coresponsibility for goal
exist with a sense of unity,
identity achievement; implies honest,
meaning, and purposefulness
soundness, and completeness
in the universe
of identifications with the
group
Need is social integrity; Need is role clarity,
knowing who one is in understanding and committing
relation to others so one can to fulfill expected tasks so
acct; role set is the complex of group can achieve common
Role function positions individual holds; goals; process of integrating
involves role development, roles in managing different
instrumental and expressive roles and their expectations;
behaviors, and role taking complementary roles are
process regulated

Need is to achieve relational
integrity using process of
affectional adequacy, i.e., the
Interdependence giving and receiving of love,
respect, and value through
effective relations and
communication
ENVIRONMENT
Need is to achieve relational
integrity using processes of
developmental and resource
adequacy, i.e., learning and
maturing in relationships and
achieving needs for food,
shelter, health, and security
through independence with
others

· 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
· Three kinds of stimuli: focal, contextual, and residual
· Significant stimuli in all human adaptation include stage of development, family, and
culture

HEALTH AND ADAPTATION

· Health: a state and process of being and becoming integrated and whole that reflects
person and environmental mutuality
· Adaptation: the process and outcome whereby thinking and feeling persons, as
individuals and in groups, use conscious awareness and choice to create human and
environmental integration
· Adaptive Responses: responses that promotes integrity in terms of the goals of the
human system, that is, survival, growth, reproduction, mastery, and personal and
environmental transformation
· Ineffective Responses: responses that do not contribute to integrity in terms of the goals
of the human system
· Adaptation levels represent the condition of the life processes described on three
different levels: integrated, compensatory, and compromised
NURSING

· Nursing is the science and practice that expands adaptive abilities and enhances person
and environment transformation
· Nursing goals are to promote adaptation for individuals and groups in the four adaptive
modes, thus contributing to health, quality of life, and dying with dignity
· This is done by assessing behavior and factors that influence adaptive abilities and by
intervening to expand those abilities and to enhance environmental interactions

NURSING PROCESS
· A problem solving approach for gathering data, identifying the capacities and needs of
the human adaptive system, selecting and implementing approaches for nursing care, and
evaluation the outcome of care provided
1. Assessment of Behavior: the first step of the nursing process which involves gathering
data about the behavior of the person as an adaptive system in each of the adaptive modes

2. Assessment of Stimuli: the second step of the nursing process which involves the
identification of internal and external stimuli that are influencing the person’s adaptive
behaviors. Stimuli are classified as: 1) Focal- those most immediately confronting the
person; 2) Contextual-all other stimuli present that are affecting the situation and 3)
Residual- those stimuli whose effect on the situation are unclear.
3. Nursing Diagnosis:step three of the nursing process which involves the formulation of
statements that interpret data about the adaptation status of the person, including the
behavior and most relevant stimuli
4. Goal Setting: the forth step of the nursing process which involves the establishment of
clear statements of the behavioral outcomes for nursing care.
5. Intervention: the fifth step of the nursing process which involves the determination of
how best to assist the person in attaining the established goals
6. Evaluation: the sixth and 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.