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Extending the Roy Adaptation Model to Meet Changing Global Needs

Callista Roy
Nurs Sci Q 2011 24: 345
DOI: 10.1177/0894318411419210

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419210
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NSQXXX10.1177/08943184

Article
Nursing Science Quarterly
24(4) 345351

Extending the Roy Adaptation Model The Author(s) 2011

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to Meet Changing Global Needs DOI: 10.1177/0894318411419210
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Callista Roy, RN; PhD; FAAN1

Abstract
The purpose of this article is to articulate how the Roy adaptation model has been extended as a conceptual framework to
meet changing global needs. Nursings social mandate is described within the significant global changes of this century. The
required synthesis of the individual and common good is predicated within the thinking of the model. Changes are described
with specific examples of groups from the family to global society levels. The implications of this work for knowledge
development are identified.

Keywords
communities, expanding adaptive modes, global society, health needs, nursing knowledge, practice applications, Roy adaptation
model, social mandate

Nursing exists as an academic discipline and a practice pro-
fession and both rely on timely knowledge development. The
last several decades have seen rapid growth in nursing
knowledge development. One synthesis of theory-based
knowledge development is described by Roy and Jones
(2007). Nursing Science Quarterly and other journals pro-
vide on-going examples of theory-based knowledge. Don-
aldson (2000) identified breakthroughs in scientific nursing
research from 1960 to 1999. These milestones were accom-
plished by what Donaldson referred to as pathfinders whose
work brought interdisciplinary change in how phenomena
were viewed. Progress in nursing knowledge development
has been great. Still significant global changes in the first
decade of the 21st century call for extending our thinking to
be more inclusive of world-wide health needs of individuals
and society. In this paper, the author presents the social
changes to be addressed and the thinking of one nurse theo-
rist in expanding a view of the individual and the common
good and of the Roy adaptation model as one approach to the
nurses providing care today and for decades to come.
Contemporary Social Mandate
for Nursing
Professions develop to meet the needs of society. The ser-
vice provided by a profession is established on knowledge
that is specialized based on the perspective of that profes-
sion. The social mandate of nursing is to contribute to the
good of society by knowledge-based practice related to
contemporary and emerging health needs. Nursing knowledge
for the common good is embedded in the changing social
and healthcare context of the future. It embraces an under-
standing of social good within philosophical assumptions
and the goal of nursing. The social context of the 21st century
now requires new knowledge. Some key issues include
changing demographics such as increasing racial and ethnic
diversity within countries, increasing variances in ages such
as greater numbers of older people in some countries and
more youth in other countries. Increasing globalization
includes the interdependence of world economies, the world
facing global warming, and technology and information
systems that are rapidly evolving at different rates across the
globe. Simultaneously, the 21st century healthcare context
has changed to include a shift to population-based care,
increasing complexity of care, evidence of unsafe care in
institutions, need for care for increasing numbers of people
with chronic conditions, and persistent health disparities
within countries, for example, rural-urban, ethnic, social-
economic, and global.
A few facts can highlight these issues. Almost 1.4 billion
people live below the international poverty line of $1.25 a
day (The World Bank, 2005) and 4.7 billion live in low and
middle-low economies, earning under $3,705 per capita
annually. The United States is one of 65 high income nations
with a population of about 1 billion or less than 1/6 of the 6.6
billion people on the earth (The World Bank, 2007). The 50
poorest countries emit 1% of the carbon emissions, yet in
1
Professor and Nurse Theorist, Boston College

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346 Nursing Science Quarterly 24(4)
some of these countries climate has been so affected as to
obliterate planting seasons with long droughts (Gray, 2009).
Facts that give evidence of global health disparities are
numerous. People suffering from malaria number 300 million
and more than 1 million die every year. Yet some countries
do not report any cases. In the human immunodeficiency
virus/acquired immunodeficiency syndrome (HIV/AIDS)
pandemic more than 25 million lives have been lost in the
past 3 decades, mostly in sub Saharan Africa. More than
30,000 children under age 5 die each day of preventable
causes, such as malnutrition, unsafe water, and the lack of
basic healthcare (UNICEF, 2001). Derber (2003) noted that
globalization promised economic stability, cultural sensitiv-
ity, international solidarity, and universal human rights.
However, in 2010 there is global economic instability, a new
influenza virus circling the globe, regional military conflicts
becoming global threats, increasing risks to building a stable
and just global society, and difficulty in putting the global
community and the earth before nationalism and financial
profits.
The increasing economically and socially polarized world
heightens the imperative to re-define the social good. Nurses
believe in the common good and also value the dignity of the
individual. Nurses are called to take on the philosophical
dialogue needed to synthesize these beliefs as a basis for
nursing practice for now and the future. The history of phi-
losophy shows many approaches to dealing with the indi-
vidual and the common good. Recently, Roy (McCurry,
Revell, & Roy, 2009) reviewed a number of these positions
and drew a synthesis of the individual and the common good
in todays world. In summary the common moral good is a
society that supports the human life and dignity of persons.
This involves an educated public that is part of a dialogue on
the emergence of valid vital needs and a moral community
that can flexibly respond to these needs. This synthesis pro-
vides a basis for disciplinary knowledge for the social man-
date of nursing. Nightingale (Webb, 2002) was a woman of
her time who became a reformer embracing the common
good because of her great concern for inequalities between
social classes. One example was working to reform the Poor
Laws and establishing workhouse infirmaries (Webb, 2002).
This decade of the 21st century expands nursings social
mandate to generate similar social transformations for build-
ing a common good that supports individual goods.
Assumptions of Veritivity and
Cosmic Unity
In speaking and writing in recent years Roy has expanded on
the philosophical assumptions of veritivity and cosmic unity.
These concepts were introduced earlier in her work (Roy,
1984b, 1988, 1996, 1997), but continue to reveal new rich-
ness in light of new demands. Exploring the principles that
stress persons and the earth having common patterns is help-
ful in taking up nursings contemporary social mandate.
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Building on the work of Swimme and Berry (1992), Roy
(2009) identified these patterns as unity, diversity, and self-
identity.
As scientists look at the origins and development of the
universe, they find more and more remarkable facts emerg-
ing from cosmology, geology, and the study of life that point
to a purposeful and ordered universe (Young, 1993). Roys
view of purposefulness includes the view that: all persons
and the earth have both unity and diversity; all are united in
a common destiny; people find meaning in mutual relations
with each other and the created world, and most often in
acknowledging a creator or God-figure that is the common
destiny or final union of all. The self identity of each indi-
vidual contributes to the universe. Each person and creature
has a unique inner spontaneous expression. The deep sense
of individuality reflects the sacred depth of each person. The
whole universe or community emerges into being from
unique properties of the individual. Based on these philo-
sophical assumptions, Roy listed the following as criteria for
the good: persons through thinking and feeling capacities,
rooted in consciousness and meaning are accountable for
sustaining the good of society that values the individual, and
for deriving, sustaining, and transforming the universe.
The social good is constituted in the goal of nursing and
nursing knowledge is derived to move toward that goal. It is
reflected in the codes of ethics and the social policy state-
ment of the profession (American Nurses Association, 2001,
2010). The goal of nursing has been explored by individual
nurse thinkers. Recent literature has used terminology such
as facilitating humanization, meaning, choice, quality of
life and healing in living and dying (Willis, Grace, & Roy,
2008, p. E28). The view of the social good of nursing as a
practice discipline is enlarged in its scope of concern and
gives human dignity a pivotal position. However, nurses find
both potential benefits as well as constraints in their efforts
to make human dignity the focus of their practice. It is not
easy to achieve a philosophical congruence that supports the
values and purpose of nursing. The further explication of
major nursing theories can provide guidance in changing and
morally demanding times to achieve the goals of nursings
social mandate.
Goal of Nursing According to the
Roy Adaptation Model
The Roy adaptation model outlines the goal of nursing as: to
promote adaptation in the four adaptive modes, contributing to
health, quality of life, and dying with dignity. Nursing based on
this model, aims to enhance system relationships through
acceptance, protection, and fostering of interdependence, and to
promote personal and environmental transformations. Within
this context the criteria for good according to the Roy adapta-
tion model is to promote adaptation of individuals and groups;
to transform a society to one that promotes dignity, and to sus-
tain and transform the universe. Reflecting on two thinkers Roy
Roy 347
used in her synthesis of the individual and common good, she
noted that nurses are to contribute to coherence of the person
and to the coherence of the world (Laszlo, 2008). Further,
nurses create the society that supports human life and dig-
nity of persons (Maritain, 1966).
Clinical Examples Using the
Adaptive Modes for Groups
The Roy adaptation model was applied to groups from its
early development (Roy, 1983, 1984a). However, in recent
years the theoretical bases have been expanded for the
physical, group-identity, role function, and interdependence
adaptive modes of groups. Nursing knowledge for practice
is developed in each adaptive mode based on theoretical,
descriptive, and predictive work on each mode. This basis
includes: needs and components as well as processes that are
integrated, compensatory, and compromised. In addition,
within and across the group adaptive modes influencing fac-
tors and stimuli are described from the perspective of the
immediate internal and external environment and global
factors. Groups are discussed at four levels: the family, orga-
nizations, communities, and global society. For purposes of
this paper the author discusses knowledge related to each
adaptive mode with practice applications to different levels
of groups including needs of both groups and society.
Physical Adaptive Mode for Family
The development of knowledge of the adaptive modes at the
group level is based on understanding the parallel mode at
the individual level, and differences in thinking required
when considering groups of relating persons as adaptive
systems. The first example is a view of the physical adaptive
mode for the family as a group. The theoretical knowledge
of the physical adaptive mode for the groups includes the
need for operating integrity, that is, wholeness achieved by
adapting to changes in resources to function as a group. The
components for the physical mode in groups include partici-
pants, physical facilities, and fiscal resources. In addition
one or more leaders emerge to coordinate the group.
Significant processes for any group in the physical mode
including families are resource management and strategic
planning. The physical resources needed for the family
include living space, nutritious food, adequate clothing,
child care, and transportation. In addition they need both
material and emotional social support. Other needed
resources are safety, that includes police and fire depart-
ments and education and recreation with schools, libraries,
public art, and parks. Fiscally the family needs employment
for expenses to cover the needs listed above, healthcare, and
plans for retirement and disability.
The goal of nursing care is to promote integrated pro-
cesses of the family, to support compensatory processes and
to identify compromised adaptation when integrated and
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Family
Seek sources of emergency aid for basic needs.
Problem-solve with family about resource management.
Guide effecve job search and maintain self-concept for individual and
group identy for the family.
Society
Join groups aiming soluons at financial policy levels.
Arrange for government hearing tesmony of effects of financial system
change on individuals and families.
Figure 1. Nursing approaches for physical mode of family with
unemployment.
compensatory processes are not effective. Nurses use such
strategies as teaching resource management; teaching risk
management to sustain a family in crisis; and identifying the
occurrence of compromised adaptation. One such physical
adaptation problem for a family could be sudden unemploy-
ment without risk management preparation. Nursing
approaches are planned to address the good of the family and
its individuals as well as the good of society (see Figure 1).
Group Identity Mode for Organizations
As another example of nursing based on understanding
groups as adaptive systems, consider the group identify
mode with the basic need for identity integrity. This need
refers to the honesty, soundness, and completeness of the
group members identification with the group. The compo-
nents include shared relations, goals, and values; co-respon-
sibility for goal achievement; and creating a social milieu
and group social culture. Central processes are shared iden-
tity and coherence. Goal-directed behavior within the group
depends on perception and understanding of the external
environment by each individual. Shared understandings then
are the cognitive, emotional, motivational, and normative
orientations of members of the social system. The individual
moves between individual identity and group identity
depending on demands of the situation. For the group the
social culture involves the agreed upon expectations, includ-
ing values, goals, and norms for relating within the group.
With groups in each adaptive mode, including the group
identity mode for an organization, the primary goal is to pro-
mote integrated processes. Some ways this is accomplished
are to support individual contributions, group coherence, and
group transformations. Another goal is to support compensa-
tory processes, which can be done by capitalizing on cohe-
siveness under external stress. Finally, the goal is to identify
compromised adaptation when integrated and compensatory
348 Nursing Science Quarterly 24(4)
Good of Group Members
 Hold meengs for nurses to discuss shared understandings, values,
and goals.
 Verify changes in expectaons that are real.
 Problem solve what is needed to manage change.
Good of Society
 Join professional organizaons to seek health system-wide soluons.
 Provide tesmony of effects of changes on nurses at unit level of
organizaon.
Figure 2. Nursing approaches for group identity mode of
organizational nursing unit with low morale.
processes are not effective by being alert for early signs of
compromised adaptation. An example of an adaptation prob-
lem in the group identity mode might occur on a nursing
unit. The issue might be that there is low morale on the nurs-
ing unit due to increasing demands without resources to meet
the demands. Again, nursing approaches are planned to
address the good of the group and individuals within the
group as well as the good of society (see Figure 2).
Role Function Mode for Communities
The role function mode applies to both individuals and
groups at all levels. The theoretical development of the
mode at the group level focuses on the need for role clarity.
The components include assigned and informal roles. The
underlying processes are socializing for role expectations,
reciprocating roles, and integrating roles. In the role function
adaptive mode, group goal achievement depends on issues,
such as how the work is divided, information managed, deci-
sions made, and order maintained.
Using the community level as an example, the goals for
the role function mode again are to promote integrated pro-
cesses, to support compensatory processes, and to identify
compromised adaptation when integrated and compensatory
processes are not effective. Integrated processes require that
the community associates with other groups to accomplish
goals and purposes. This approach includes that the commu-
nity keep support of external funding agencies, and also
share respect and value for all other group interactions. The
nurse in the community is aware that adaptation problems
may be sudden or slow in developing. Consider a commu-
nity with several rural towns in a given geographic area as an
example of a slowly developing strain on integrated and
compensatory processes that may have sudden changes lead-
ing to compromised processes. A pandemic outbreak of a
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new influenza virus such as spreading of the 2009 H1N1
virus was such an example.
Although estimating the number of individual flu cases in
the United States is difficult, the Center for Disease Control
(CDC) provided estimates from April to November 14, 2009.
Approximately 47 million people were infected; 213,000
had H1N1-related hospitalizations; and there were about
9,820 H1N1-related deaths (CDC, 2009). When the new flu
viral strain was identified and the future spread unclear,
communities began to organize to handle the challenge. Two
of the goals of the United States National Vaccine Plan were
to develop new and improved vaccines and to enhance the
safety of vaccines and vaccination (Institute of Medicine,
2009). The American Nurses Association noted that in the
H1N1 pandemic, nurses could be an educated voice of reas-
surance to the community; educate patients and communities
to protect themselves; and if the current disaster plan does
not include measures for a pandemic, advocate for such plan-
ning (American Nurses Association, 2009).
Thus, at the community level the focus is on interacting
with the federal and state systems of production and distribu-
tion of vaccines to plan administration of the vaccine to vul-
nerable populations. In addition, remote plans are made to
activate a disaster plan to handle a potential overload of
cases of persons with the flu. A nurse is the head of the Board
of Health in one town and her town has the one hospital
equipped to take the seriously ill and thus is designated the
site for use for the very ill. Another town took responsibility
to organize flu clinic dates in one place for all three towns.
The nurse leader was able to recruit enough volunteers to
staff the clinic. Another nurse took responsibility to work
with the public media to keep people informed about the
facts of the outbreak and possible ways to maintain inte-
grated health. The community made up of three towns was
suddenly put in compensatory mode when the supplies of
vaccine failed to be delivered at the times planned. Secondly,
the nurses again took on the role of being an educated voice
for the public and negotiating roles when one batch of vac-
cines was recalled as ineffective.
In working to avoid compromised adaptation for their
community the nurses of the three towns learned a great deal
more about what could be done to promote the common
good in the one issue of the national plan for vaccination.
They began to advocate for the creation of the basis for a
prioritized national vaccine safety research agenda that
would cover all federal agencies and include all stakeholders
who conduct research related to such safety (Institute of
Medicine, 2009). Along with advocacy the nurses joined the
movement recommending the development of a national
communication strategy on vaccines and immunizations,
reflecting current research as well as attention to the needs of
individuals and groups such as literacy, linguistics, and cul-
ture (Institute of Medicine, 2009).
Roy 349
Interdependence Mode for
Global Society
The interdependence mode has been developed at the group
level and can be applied from the family to the global soci-
ety. The underlying group need is for relational adequacy.
The components of the group interdependence mode are
context, infrastructure, and member capability. The external
context includes economic, social, political, and cultural fac-
tors, while the internal context is the groups mission, pur-
pose, vision, values, beliefs, and goals. The infrastructure for
every group has both formal and informal procedures,
activities, and systems in interaction. The member capabili-
ties include cognitive coping abilities, knowledge, skills,
commitments, and attitudes. The processes underlying this
mode are relational, developmental, and resource adequacy.
The clinical example of the interdependence mode, together
with the other assumptions and elements of the Roy adapta-
tion model, is focused on integration of global society.
Roy comes to this discussion from previous work describ-
ing the potential of the outcome of the model in 2050 (Roy,
2007). At that time Roy described an alternative way of char-
acterizing eras of human thought. Since the word modern
means the most recent, it seems logical to use the word for
current thought and to divide previous modern thought into
epochs. For example, Modern Thought, Epoch 1 can refer to
the age of rationalism and empiricism from 1543 to the early
20st century. Modern Thought, Epoch 2 began in the 20th cen-
tury and included multiple ways of knowing. Later Modern
Thought, Epoch 3 emerges from 2013 to 2045 with inte-
grated knowledge that creates a complete, unified and har-
monious whole, representing various perspectives, with the
subsumed value of meeting the needs of all persons. This is
followed by Modern Thought, Epoch 4, which is dated as
beginning from 2045 to 2050 and refers to a new period of
creativity participated in by the entire Earth community. It
involves imaginative and transforming powers where human
institutions reflect depth experience of forces of the universe.
The spiritual mode of human consciousness is activated and
the human social order and cosmologic order are harmo-
nized. Shared experiences, traditions, and shared values are
the cement of society and shared purpose and shared values
form a common will (Roy, 2007).
In more recent presentations Roy (2008) explored the
notion of global consciousness. She drew upon Laszlos
(2008) view of the global brain, described as the quasi-neural
energy-information-processing network created by 6 billion
people on the planet, interacting in private as well as in pub-
lic, locally as well as globally. Laszlo described a quantum
shift as the sudden and fundamental transformation in the
relations of a significant segment of 6.5 billion people to
each other and to nature that involve transformation in per-
ceptions of reality. Roy related this view to the global brain of
nursing, that is, quasi-neural energy-information-processing
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network created by the more than 11 million nurses around
the globe interacting publically and privately. A quantum
shift for nursing is viewed as a sudden and fundamental
transformation in the relations of a significant segment of
more than 11 million nurses globally to each other and to
nature, that is, transformation in perceptions of reality.
Nursing can provide an exemplar of envisioning a different
global society, where health needs are seen as primary.
Resources are channeled to meet health needs worldwide for
the individual and the common good.
Roy envisions that global forms of governance in 2050
can reflect integrated societies that maintain the richness of
all cultures. Individuals and societies accept, protect, and
foster interdependence of the inner energy of people and the
earth and energy is used to promote good of all people
globally.
The strategies to get to this goal are derived from Laszlo
(2008).
Include promoting relationality, interconnections,
and networks.
Give primacy to human experience, synergy and
global consciousness.
Shift from competition to reconciliation and part-
nership.
Shift from greed and scarcity to sufficiency and caring.
Shift from outer to inner authority.
Shift from mechanistic to living systems.
Shift from separation to wholeness.
Move from conflict to dialogue.
Spread peace and ecology movements.
Move national and international change toward
peaceful and cooperative lifestyles and governance
structures.
Another author followed the same thinking and noted that
people are drawn into a new global identity beyond national-
ity, ethnicity, and religion that have separated people
(OMurchu, 2002). People have evolved and developed
from relational matrices for thousands of years. Within the
principles of the Roy adaptation model one can leave behind
the images and projections that foster destructive alliances.
Knowledge Development Using the
Roy Adaptation Model
The Roy adaptation model has been developed as a guide for
nursing practice in a world with emerging needs. In addition,
the model provides a blueprint for knowledge development.
The assumptions of the model provide a value-based per-
spective to identify significant issues for scholarly inquiry
using multiple ways of knowing. The person, environment,
and adaptation level concepts of the model provide multiple
possibilities for investigators to build integrated knowledge
350 Nursing Science Quarterly 24(4)
1970 to 1994 1995 to 2001
n = 112 n = 50
Proposions supported: n = 236/275 (83%) n = 95/118 (81%)
High potenal for
implementaon in pracce: 60 studies (54%) 37 studies (74%)
Figure 3. Integrated knowledge as evidence for practice based
on the Roy adaptation model (Roy, 2009).
of integrated health of people as individuals and groups in a
changing global society. In two reviews of research based on
the Roy adaptation model (Boston Based Adaptation Research
in Nursing Society, 1999; Roy Adaptation Association, 2001),
a high level of support was found among propositions tested.
When criteria were devised for providing evidence for prac-
tice a number of studies were judged to have high potential for
implementation in practice (see Figure 3).
Conclusion
Seeds have been planted of a new epoch for knowledge
development to meet the changing global needs. The future
holds hope and promise for transformations for the flourish-
ing of people and the earth. The high level of scholarship
established by many nurses using this particular theoretical
work over many decades portends well for the continued
raising for nurse scholars to meet the challenges in the sec-
ond decade of the 21st century and to prepare for the rapid
development of the nursing role in the global community.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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