Callista Roy created the Roy adaptation Nursing Model (RAM) in 1976. This model is based on the patient’s ability to adapt.
Roy explained that adaptation is the ability to respond positively to changes in the environment. Roy suggested that the goal of the nursing process should be based on how to promote adaptation.
The development of this model was influenced by Roy’s personal clinical experiences, family, religious background, education, mentors.
The model asks a set of three questions
- Who is the focus of your nursing care?
- When will you need to provide this patient care?
- What are you going to do to provide this patient care?
These questions should be answered to provide general patient care. The nurse must make sure that he or she is clear of these questions when providing care to their patients.
Roy’s model is different from the Domains of nursing in that it focuses on adaptation rather than on determinants of health and illness. Roy’s adaptation model is a framework for critical thinking and clinical judgment. It helps the nurse decide the best course of action, and it provides the standard for providing patient care.
Assumptions of the Model
- People have mutual ties with the rest of the world and with God.
- The omega point convergence of the universe is where human meaning is anchored.
- People make use of their consciousness, enlightenment, and faith creative talents.
- The processes of generating, sustaining, and modifying the cosmos are all under the control of people.
- The diversity of creation reveals God intimately, and God is the common destiny of creation.
- Experiences within a specific culture will influence how each element of the RAM model is expressed
- Within a culture, there may be a concept that is central to the culture and will influence some or all of the elements of the RAM to a greater or less extent
- Cultural expressions of the elements of the RAM may lead to changes in practice activities such as nursing assessment
- As RAM elements evolve within a cultural perspective, implications for education and research may differ from experience in the original culture
- 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
- Human decisions are accountable for the integration of creative processes
- Thinking and feeling mediate human action
- System relationships include acceptance, protection, and fostering interdependence
- Persons and the earth have common patterns and integral relations
- Person and environment transformations are created in human consciousness
- Integration of human and environmental meanings results in adaptation
Major Concepts in the Model
The major concepts in the model are a person as an adaptive system, the environment as the stimuli, adaptation as the goal of nursing, nursing as the promotion of health, and health as the outcome of adaptation.
Roy’s adaptation model defines a person as a biological, psychological, and social system. The person is the unit of analysis in nursing care.
A person being the adaptive system is in constant interaction with the environment.
The person is always focused on all three levels of analysis (biological, psychological and social.) These levels of interactions generate meanings that are the focus of the RAM.
A person includes individual groups like the family, a community, society or the human race.
The environment consists of stimuli that promote or inhibit human adaptation. The environment provides resources for health care, both tangible (clinical) and intangible (relationships).
The environment can be internal or external to a person. It includes the social and physical environment. Environmental factors have an effect on adaptation.
Adaptation is a process that helps organisms survive by overcoming changes in their external or internal environments. Adaptation means responding to the changes in the environment positively.
Adaptation can be active or passive. Passive adaptation does not have a direct effect on the environment. It is a way of managing what is available. Active adaptation directly affects the stimulus and changes it into something healthier for a person to survive.
Active adaptation includes behaviors and activities that promote health.
The goal of nursing is an adaptation using the person’s abilities to modify and maintain internal and external environments. Adaptation can be positive or negative. It corresponds with Roy’s words: “if it results in greater integration, freedom, wellbeing for the person, it is beneficial. If not, then it is harmful.”
Health as a concept is used as an indicator of integration, meaning that when there is less fragmentation (disorganization) in a system, the health improves.
Health is not just the absence of disease but can also be described as the ability to adapt to environmental demands that lead to greater integration and well-being.
Human decisions are accountable for integrating creative processes (consciousness and meaning) in relationship with others and environment inter-relationships. These relationships occur at the being level of a person, where his wholeness can’t be separated from relationships.
Four Adaptive Modes
The four adaptive modes are physiological, self-concept, role function, and interdependence.
The four modes work together in a unified system called an adaptive cycle. The function of the cycle is for a person to move from a state of disorder to a state of order, which results in health. The mode inter-relationships also unfold as systems within systems. These modes are the outcome of Roy’s research and experience over several decades.
Physiological mode is the first level of order characteristic of life activity through exchanges with environmental conditions. This mode is characterized by self-regulation and homeostasis.
Although the person is adaptive in this mode, they are not yet a whole figure. Their behavior is more instinctive and reactive rather than deliberate and reflective. They can perform physical activities but lack control over some of them.
To promote integrity in this mode, five needs are addressed. The needs include nutrition, oxygenation, elimination, activity and rest.
This mode is the second level of order. It involves personal uniqueness and individual behavior. The focus here is on what people believe they are capable of doing. Here is where the mind-body dichotomy is formed.
It is in this mode that a person’s feelings and beliefs about himself/herself are addressed.
Role function mode
The role function is the third level of order where social roles take place. This mode is characterized by a person’s abilities to perform those social activities expected from his/her role.
In this mode, the focus is on what a person does as part of daily life. In relation to other modes, it paradigmatically describes how health and disease are viewed.
This mode is the fourth level of order, and it has its focus on what a person does with other people and society as a whole. It is here where the person remembers his/her connections to enrich their lives.
In this mode, we ask ourselves: “How does a person function in relationship with others and society as a whole? How does he/she feel about their community?”
The cycle of the four adaptive modes is completed when a person experiences satisfaction from those needs. Then, there is an opportunity for growth through a commitment to attain greater wholeness.
The Roy adaptation model has a six-step nursing process which consists of:
- Assessment of behavior
- Assessment of stimuli
- Nursing diagnosis
- Goal setting
Assessment of behavior
This is the first step in Roy’s nursing process. Here, the nurse observes how a client responds to different stimuli. Assessment should be done on all four adaptive modes.
The information collected will help establish or refine nursing diagnosis and goal setting for interventions.
Assessment of stimuli
In this stage, the nurse evaluates what triggers changes in the client’s behavior. It will help in the identification of stimuli that elicit positive and negative responses from the person. This stage also involves looking for stimuli specific to each mode.
Roy’s nursing process states that nursing diagnosis should be made according to what affects the four modes. The nurse should show how a problem or goal affects the person.
It is important to remember that one nursing diagnosis can affect any or all of the modes during this step.
For example, if a client had difficulty breathing and was placed on mechanical ventilation, there would be implications on physiological mode (that is, respiratory function) as well as self-concept mode (for instance, the client might have feelings of being weak or defeated), interdependence mode (the client would be stressed by the need to depend on others to perform daily activities) and role function mode (for instance, family members might feel guilty if they do not take good care of their ill relative).
In the goal-setting stage, the nurse should establish a path for growth and development to help a person attain optimal wholeness.
This requires a clear understanding of how problems affect each mode so that goals can be established accordingly. It is also important to note that there might be more than one problem affecting a single-mode or more than one goal affecting a single problem.
In this step, the nurse implements strategies to help clients attain optimal wholeness according to established goals. It is important that nursing interventions be placed within each mode and relate to the focus of each stage.
For example, if a client with depression was asked to perform activities that would improve self-concept mode, it would be helpful for the nurse to provide hope.
In this stage, nurses should monitor changes in the client’s health status and coping mechanisms. This includes looking at how problems affect each mode, goal attainment and whether or not any barriers prevent successful implementation of an intervention plan.
This is also where the nurse evaluates whether or not goals have been met. Future plans should be drafted depending on the client’s condition before, during and after goal attainment.
The Roy adaptation model requires a strong understanding of how problems affect each mode to correctly identify nursing diagnoses and establish intervention strategies. This helps in promoting human and environmental integration for optimal wholeness and growth.
Strengths of Roy’s Adaptation Model
The Roy adaptation model has four integrative concepts with which it can explore the wholeness of an individual.
Each mode is interconnected and dependent on one another. The strength of the model lies in its ability to integrate these four modes into nursing practice.
- The Roy adaptation model needs a lot of time and effort to implement.
- The Roy adaptation model also needs to be re-adapted since there are variations in people’s lifestyles. This calls for resources and energy that not all nurses have.
The Roy adaptation model of nursing is an integrative nursing theory that focuses on how people adapt to change. The model provides a framework of understanding for nurses to observe and assess individual situations. Furthermore, the Roy adaptation model allows the development of intervention strategies based on how problems affect each mode. However, this requires resourcefulness and efforts from not only nurses but also patients.