SISTER CALLISTA ROY:

THE ADAPTATION MODEL

By:
Caroline Gates, RN, BSN
Carol Marrs, RN, BSN
Preethi Unjakoti, RN, BSN
 When I consider your heavens,
The work of your fingers…
What is man that you are mindful of him,
The son of man that you care for him?
You made him a little lower than the heavenly beings
And crowned him with glory and honor
You made him ruler over the works of your hands
Psalm 8: 3-6
 Introduction of the Theory and Theorist
2

Preethi Unjakoti
 Sister Callista Roy
3
Born in Los Angeles,
California, on October 14,
1939
Second child of Mr. and Mrs.
Fabien Roy
Family of seven boys and
seven girls
She was named after Saint
Callistus of the Roman
Catholic Calendar.
Mother was a licensed
vocational nurse
Roy, Sr. C., Zhan, L., & Parker, M. E., ( 2006). Nursing Theories & Nursing Practice.
Second Edition. Philadelphia, PA: F. A Davis Company
 Education
4

 Bachelors Degree in Nursing from

Mount St. Mary’s College in 1963.

 Masters in Pediatric Nursing from

University of California in 1966

 Suffered with Encephalomyelitis, a neurological disorder.

 Second Masters and PhD in Sociology in 1973 and 1977

 She finished her postdoctoral program in Neuroscience

Nursing.
Roy, Sr. C., Zhan, L., & Parker, M. E., ( 2006). Nursing Theories & Nursing Practice.
Second Edition. Philadelphia, PA: F. A Davis Company
Professional Experience
5

Started at age 14.

Pediatric Nurse
Nursing instructor in many
different capacities.

Currently she is the Professor and

Nurse Theorist at the William F.
Connell School of Nursing, Boston
College.

Roy, Sr. C., Zhan, L., & Parker, M. E., ( 2006). Nursing Theories & Nursing Practice.
Second Edition. Philadelphia, PA: F. A Davis Company
 Personal and Professional Influences
6

Her family, mainly her mother

Her religious beliefs

 She became a member of the Sister
Of Saint Joseph of Carondelet

Her teachers and mentors

Dr. Dorothy Johnson

 Challenged Ms. Roy to develop her
Nursing theory. Roy, Sr. C., Zhan, L., & Parker, M. E., ( 2006). Nursing Theories & Nursing Practice.
Second Edition. Philadelphia, PA: F. A Davis Company
 Worldview
10

Three different worldviews:

 Rationalism
 Relativism
 Veritivity

Veritivity is Ms. Roy’s worldview

“It is capable of providing a worldview of cosmic

unity, by which persons and environment are
integrated and achieve a final common destiny.”
Retrieved from http://www.bc.edu/schools/son/faculty/featured/theorist/Roy_Adaptation_Model/
 Introduction of The Model/Theory
7

Adaptation was first

introduced to Ms. Roy in a
psychology class

Adaptation of children

Theory development started in 1964

 First utilized in Mount St. Mary’s College

Alligood, M. R., & Ann Marriner T., (2010). Nursing theorists and their
work. Seventh edition. Maryland Heights, MO: Mosby Elsevier.
 Primary Concepts of the Model
9

Key concepts are the Person (or a group) viewed as a

adaptive system, their health, and their environment.
 A person is a bio-psyco-social being.
 Both innate and acquired mechanisms are used for coping.

*******The main concept*******

Assessment of behavior and the factors affecting

adaptation, and intervention to promote adaptive
abilities and enhance environmental interactions.
Johnson Lutjens, L. R., (1991). Callista Roy: An Adaptation
Model. Newbury Park, CA: SAGE Publications, Inc
 Metaparadigm: Person
11

Person is viewed as a holistic adaptive system

Engaging in and interchanging with the environment
Person also refers to families, groups, communities
and the whole society.
Andrews, H. A., & Roy, Sr. C., (1999). The Roy Adaptation Model. Stamford, CT: Simon & Schuster Company.
 Metaparadigm: Health
12

Health is the state and a process of being and

becoming an integrated and whole person.
It is a process where he or she is striving to achieve
their maximum potential.

Andrews, H. A., & Roy, Sr. C., (1999). The Roy Adaptation Model. Stamford, CT: Simon & Schuster Company.
 Metaparadigm: Environment
13

All conditions, circumstances, and influences.

A change acts as a catalyst and causes adaptive

responses.

Andrews, H. A., & Roy, Sr. C., (1999). The Roy Adaptation Model. Stamford, CT: Simon & Schuster Company.
 Metaparadigm of Nursing
14

Nursing acts to enhance the interaction of the person

with the environment to promote adaptation
It is the science and practice that expands adaptive
abilities.

Andrews, H. A., & Roy, Sr. C., (1999). The Roy Adaptation Model. Stamford, CT: Simon & Schuster Company.
 Sister Callista
Roy’s Adaptation
Model
and Application
Putting it all together
4
 Roy’s Model Continued…

Coping mechanisms: Regulator and Cognator

Control Processes: Stabilizer and Innovator

ADAPTATION
 Four Adaptive Modes
1. Physiological- oxygenation, nutrition, elimination, activity, rest, and
protection

2. Self Concept- Psychological and spiritual elements

3. Role Function- primary,secondary, and tertiary roles the person performs

in society
4. Interdependence- coping mechanisms arising from close relationships

Goal: Promote integrated adaptation in all four modes = HEALTH

Four Adaptation Modes
Apply the Nursing Process to Each of the Four
Adaptive Modes
1. Assess Behavior

2. Assess Stimuli

3. Nursing Diagnosis

4. Goal Setting

5. Interventions

6. Evaluation

ULTIMATE GOAL: Promote integrated adaptation in each of the

Four Adaptive Modes
 Visual Aid

Roy’s Adaptation Model

Person-open
system

Environmental Stimuli: Focal, Contextual,

Residual

Adaptation level: integrated,

compensatory, or compromised. Nursing

Health
 Examples of Roy’s Model in Practice
 Cancer patients -Cook(1999), Gerrish (1989)
 Amputations - Dawson (1998)
 Occupational Health -Doyle & Rejacich (1991)
 Pt’s with Anxiety- Fredrickson (1993)
 Hospitalized Children- Galligan (1979), Starn & Niederhauser (1990)
 Coronary Care Unit- Hamner (1989)
 Adolescents with Asthma- Hennessy-Harstad (1999)
 Adult Hemodialysis patients- Keen et al. (1998)
 Home care- Lankester & Sheldon (1999), Schmitz (1980)
 Abused Women- Limandri (1986)
 Patients with Kawasaki disease- Nash (1987)
 Adolescents with bulimia nervosa- Pilote (1998a,1998b)
 Elderly in apartment complexes- Smith (1998)
 Patients with alzheimer’s disease- Thornbury & King (1992)
 * List obtained from Fitzpatrick and Wall (2005)
More recently...Suggested use in Community
Health Nursing
13

 Physical-morbidity/mortality stats,
medical facilities, funding

 Group identity-culture,morale

 Role function-effectiveness and

accountability of institutions (fire,
police, hospitals)

 Interdependence-relationships of
community with outside
organizations, quality of
relationships within the
community

 * Dixon, E.L. (1999). Community health

nursing practice and the Roy adaptation
model. Public Health Nursing 16(4), 290-
300. 13
Examples of Roy’s Adaptation Model in Research
16

 Cross-cultural pain- Cavillo & Flaskerud (1993)

 Caesarean birth- Fawcett (1990)
 Child-bearing women- Fawcett & Tulman (1990), Tulman et al. (1998)
 Cancer patients- Frederickson et al. (1991), Samarel et al. (1998)
 Spinal cord injury patients- Harding-Okimoto (1997)
 Abused women- Limandri (1986)
 Well adolescents- Modrcin et al. (1998)
 Breast-feeding women- Nyqvist & Sjoden (1993)
 Spouses of surgical patients- Silva (1987)
 Elderly persons- Smith (1988), Zhan (2000)
 Persons with Alzheimer’s disease- Thornbury and King (1992)
 * List obtained from Fitzpatrick and Wall (2005)

16
 More recently...

• * Yoder, L. H. (2005). Using the Roy

adaptation model: A program of research in
a military research service. Nursing
Science Quarterly 18(4), 321-323.

 Brooke Army Medical Center and U.S. Army Institute of Surgical Research-
Series of studies based on Roy’s Adaptation Model

 1. Quality of life experienced by people with cancer. Findings: Military patients

did not share with their healthcare provider about pain, sexual dysfunciton,
ect. because they viewed these as expected.

 2 Investigate feasibility of exercise program and examine the effects on

physiological and psychological parameters of health in Cancer patients.
Findings: Improved exercise tolerance, activity, sleep patterns, and quality of
life.

 Excellent guide for Quality of Life outcomes in patients with long term illness
 Examples of Roy’s model in Education
19
One of the most widely used models in the U. S. for
nursing education
Geriatric Nurse-Practitioner Program
University of Ottawa School of Nursing, Canada
Mount Saint Mary’s College, Los Angeles
 Students deliver care based on Roy’s model
 http://www.msmc.la.edu/undergraduate-bachelor-programs/nursing/bachelor-of-science.asp

*Source: Fitzpatrick & Wall, 2005

 Roy’s Model Applied to Administration
20

 A research study explains how one hospital implemented Roy’s model to develop :

• A Nursing Philosophy

• Mission Statements

• Standards of Practice

• Job Descriptions

• Performance Planning and an Appraisal System

• A Quality Monitoring System

CONCLUSION: highly integrated system of nursing administration and practice

*Rogers et al.,1991
Caroline Gates RN
 Evaluation of Model

Adequacy
 Model developed from
belief based mainly on
pediatric clinical
observations

 Use of Harry Helson’s

adaptation theory

(Patton, 2004)
 Evaluation of Model

Clarity
 Adaptation
-How is it defined?
-Who defines it?
-How is it evaluated?

 Health
-Non-specific definition

(Lewis, 1988; Patton, 2004)

predictions
 Evaluation of Model

Clarity
Adaptive modes have unclear
boundaries
-Interrelated by perception
 Some use of theoretical jargon
 Good assessment
method
(Lewis, 1988; Patton, 2004)
 Evaluation of Model
Adaptation
Complexity
 Abstract and difficult to Coping Control
understand
Regulator Cognator Stabilizer
 Concept of Person as an Innovator
adaptive system
Cognitive
Emotional
 Cognator and regulator
subsystems Output processes

Central processes
 Not easily operational for
research
Input
-stimuli create an extensive
list of potential variables

Tolson & McIntosh, 1996

 Evaluation of Model

Completeness

 Addresses all four concepts of a nursing model (metaparadigm)

 Comprehensive and systematic assessment

- Observed behavior is reflective of the parts


Focus on the individual
-> More of a downstream approach
Smaller perspective

 Person = adaptive system

-> Little room for humanistic
understanding
 Clinical Use of the Model for FNPs in primary
care setting

Develops systematic and

comprehensive ways of
knowing reality
Promotes critical thinking
Focused on the Person
-rights, liberty, and
independent actions
 Clinical Use of the Model for FNPs in primary
care setting
Helps visualize the nursing
process as a dynamic
continuum -> the patient’s
progress becomes the driving
force within the process
Provides guidance for
intervention that can enhance
quality of life and enhance
interaction of the person with
the environment
 Adaptation to chronic illness
 Family functioning
 Clinical Use of the Model for FNPs in
primary care setting

Limited by the perception of

adaptation
 -> need to identify client’s
perception of the problem
 The meanings attached to the
experience
 Then assist the client in
forming realistic goals in
coping with the problem
 Clinical Use of the Model with a Geriatric
Population

Assess circumstances that might contribute to a

premature admission to a long term care facility.
 Role reversal
 Powerlessness
 Difficulty coping with

disability
 Adaptation of significant
other

Farkas , 1981
 Clinical Use of the Model for Cardiac Health

 Chest pain, decreased levels

of activity, fluid overload,
sleep disturbance (physiologic
mode)
 Fear, anxiety, body image
disturbance due to bypass
surgery (self-concept mode)
 Increased dependency on
others (role function)
 Relationship needs unmet
(interdependence mode)
 Self-esteem issues
(interdependence mode)
 Conclusion

Research supports Roy’s model as evidence based

nursing process
Widely used in different settings and has enduring
characteristics (based on system’s theory)(Alligood, 2010)
Updated as knowledge increases and trends change
(Alligood, 2010)

In a world of globalization, the model is limited by an

egocentric paradigm (Cody, 2006)
Limited by the view that the individual good is the
highest good to be achieved (Cody, 2006)
 References
33
• Alligood, M. R. (2010). Nursing theory: Utilization and application.
Maryland
Heights, MO: Mosby, Inc.
• Cody, W. (2006). Philosophical and Theoretical Perspectives for
Advanced Nursing Practice. (4th Ed.). Sudbury, MA: Jones and Bartlett.
• Cunningham, D. A. (2003). Application of Roy’s adaptation model when caring for a
group of women coping with menopause. Journal of Community
Health
Nursing, 19(1), 49-60.
• Dixon, E.L. (1999). Community health nursing practice and the Roy adaptation
model. Public Health Nursing 16(4), 290-300
• Farkas, L. (1981). Adaptation problems with nursing home application for
elderly persons: an application of the Roy adaptation nursing model.
Journal of Advanced Nursing (6), 363-368.
• Fitzpatrick, J.J., & Whall A.L. (2005). Conceptual models of nursing: Analysis and
application. Upper Saddle River, NJ: Pearson Education, Inc.
• Lewis, T. (1988). Leaping the chasm between nursing theory and practice. Journal
of Advanced Nursing (13), 345-351. 20
 References Continued

• Patton, D. (2004). An analysis of Roy’s Adaptation Model of nursing as

used within acute psychiatric nursing. Journal of Psychiatric and Mental
Health Nursing (11), 221-228.
• Roders, M., Paul, L. J., Clarke, J., Mackay, C., Potter, M., Ward, W. (1991). The use of
the Roy Adaptation Model in nursing administration. Canadian Journal of
Nursing Administration 4 (2), 21-26.
• Tolson, D, McIntosh, J. (1996). The Roy Adaptation Model: a consideration of its
properties as a conceptual framework for an intervention study. Journal of
Advanced Nursing (96), 981-987.
• Villareal, E. (2003). Using Roy’s adapation model when caring fpr a group of young
women contemplating quitting smoking. Public Health Nusing, 20(5), 377-
384
• Yeh, C.H. (2001). Adaptation in children with cancer: Research with Roy’s model.
Nursing Science Quarterly 14(2), 141-148.
• Yoder, L. H. (2005). Using the Roy adaptation model: A program of research in a
military research service. Nursing Science Quarterly 18(4), 321-323.