Sister Callista Roy 1939-Present Adaptation Model

Career History

1963- Received bachelors degree in nursing from Mount Saint Marys College in Los Angeles 1966- Received her masters degree in nursing from University of California, Los Angeles 1973-Received masters degree in sociology 1977- Received doctorate in sociology from University of California 1968- Began operationalizing her model when mount Saint Marys College adopted the adaptation framework as the philosophical foundation of the nursing curriculum. 1970- The Roy adaptation model was first presented in an article published in Nursing Outlook entitled Adaptation: A ConceptualFramework for Nursing

Achievements

^^^ Associate professor and chairperson of the Department of Nursing at mount Saint Marys College until 1982 ^^^ Promoted to rank professor in 1983 at both Mount Saint Marys College and University of Portland ^^^ She was a Robert Wood Johnson postdoctoral fellow at the University of California, San Francisco, as a clinical nurse scholar in neuroscience. ^^^ Roy began the newly created position of the nurse theorist at Boston College School of Nursing in 1987. ^^^ She has published many books, chapters, and periodical articles including The Roy Adaptation Model. ^^^ And she has presented numerous lectures and workshops focusing on her nursing adaptation theory. ^^^ Honorary Doctorate of Humane Letters by Alverno College in 1984 ^^^ Honorary doctorates from Eastern Michigan University in 1985 And St. Josephs College in Maine in 1999

Awards received

///// Member of Sigma Theta Tau ///// received the National Founders Award for Excellence in Fostering Professional Nursing Standards in 1981. ///// American Journal of Nursing Book of the Year Award for Essentials of the Roy Adaptation Model. ///// Recipient of a Fulbright Senior Scholar Award from the Australian-American Educational Foundation in 1989. ///// Recipient of Martha Rogers Award for Advancing Nursing Science from the National League for Nurses in 1991. ///// received the Outstanding Alumna Award and the prestigious Carondelet Medal from her alma mater, Mount Saint Marys.

OBJECTIVES

At the end of my report my classmate will be able to: 1. describe the adaptation model of Sister Callista Roy. 2. identify the differences of the old model to the revised adaptation model. 3. discuss the metaparadigm of Roys adaptation model. 4. understand the major concepts in the theory.

Major Concepts and Definitions

System----a set of part connected to function as a whole for

some purpose and that does so by virtue of the interdependence of its parts. In addition to having wholeness and related parts, systems also have inputs, outputs, and control and feedback processes.

Adaptation Problems----are broad areas of concern related to adaptation. These describe the difficulties related to the indicators of positive adaptation.

Integrity--------------------------the degree of

wholeness achieved by adapting to changes in needs.

Adaptation-----------------------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

Major Concepts
Adaptation Level- -------------represents the condition of the life processes

Three levels Integrated Life Processes---------refers to the adaptation level at which the structures and functions of a life process are working as a whole to meet human needs

Compensatory Processes --- regulator and cognator subsystems are activated to search for the integration of life processes
Compromised Processes ------life processes present inadequate integration, characterizing an adaptation problem

Stimuli----------------------------any change in the

internal or external environment that induces a
response in the adaptive system Three types. Focal Stimulus------------------ the internal or external stimulus most immediate confronting the human system. Contextual Stimuli- -----------are all other stimuli present in the situation that contribute to the effect of the focal stimulus. Residual stimuli-----------------are environmental factors within or without the human system with effects in the current situation that are unclear

Coping Processes---------------------innate or acquired

ways of interacting with the changing environment

Innate Coping Mechanisms-- -- are genetically determined or common to the species and are generally viewed as automatic processes; humans do not have to think about them. Acquired Coping Mechanisms-- are developed through strategies such as learning. The experiences encountered throughout life contribute to the customary responses to particular stimuli

Coping Mechanism Subsystems

Individual

Regulator Subsystem---------is a major coping process involving the neural, chemical, and endocrine systems Cognator Subsystem---------is a major process involving four cognitive-emotive channels: perceptual and information processing, learning, judgment, and emotion

Group Stabilizer Subsystem----------the stabilized structures, values and daily activities whereby participants accomplished the primary purpose of the group and contribute to common purposes of society Innovator Subsystem----------- refers to cognitive and emotional strategies that allow a person to change to higher levels of potential

Behavior------------------------------an action or

reaction to a stimulus A behavior may be observable or non-observable. An example of behaviour is pulse rate; non-observable behaviour is a feeling experienced by the person and reported to the nurse.

Adaptive Responses-----------are those that promote integrity in terms of the goals of human systems Ineffective Responses----------are those that do not contribute to integrity in terms of the goals of the human system

Four Adaptive Modes

Physiological-Physical Mode
The physiological part refers to the way the individual physically interacts with the environment through his organs and organic components. The basic need is physiological integrity.

Five needs are identified in the physiologicalphysical mode

1. oxygenation 2. nutrition 3. Elimination

4. Activity and rest 5. Protection

Four complex processes

1. 2. 3. 4.

Senses Neurological function Fluids and electrolytes Endocrine function

The physical mode is the manner in which the collective human adaptive system manifests adaptation relative to basic operating resources, participants, physical facilities, and fiscal resources. The basic need of the physical mode is the operating integrity

Self Concept- Group Identity Mode----------------is one of the three psychological modes and it focuses specially on the psychological and spiritual aspects of the human system.

Self-concept is defined as the composite of beliefs and feelings about oneself at a given time and is formed from internal perceptions and perceptions of others reactions. The basic need has been identified as psychic and spiritual integrity.

Two components

Personal self---incorporates self-consistency, selfideal, and moral-ethical-spiritual self Physical Self---incorporates body sensation and body image

Group identity mode----reflect how the people in groups perceives themselves based on environmental feedback and the basic need is identity integrity.

Components

interpersonal relationship group self-image social milieu and culture

Role Function Mode--------- involves the roles that an

individual performs in society or the actions associated with the infrastructure of a group. Social integrity is the goal of role function mode.

Role----defined as a set of expectations about how a person occupying one position behaves toward a person occupying another position

Instrumental behaviour---the behaviour that persons perform as part of their roles. Expressive behaviour------feeling and attitude held by the person about performing the role.

Roles

Primary role determines the majority of the behaviour engaged in by the person during a particular period of life. Example is the developmental level such as generative adult female. Secondary roles are those that a person assumes to complete the task associated with the developmental stage and primary role. Example of this will be wife, mother, and teacher.

Tertiary roles are related primarily to secondary roles and represent ways in which individuals meet their role associated obligations....Tertiary roles are normally temporary in nature, freely chosen by the individual, and may include activities such as clubs or hobbies. The example of this is, the mother role might involve the role of parent-teacher association president for a given period.

Interdependence Mode-------focuses on close

relationships of people and their purpose, structure, and development. The basic need of this mode is termed relational integrity.

Two relationships

Independence- includes mastery of obstacles and initiative taking

Dependence- includes affection seeking, help seeking, and attention seeking

Group/ components

Contex Infrastructure Participants

Nursing Process and Critical thinking in Roy Adaptation Model

Nursing process is a goal-oriented, problem solving approach to guide the provision of comprehensive, competent nursing care to a person or groups of person. According to Andrews and Roy, nursing process relates directly to the view of the person as an adaptive system.

Six simultaneous, ongoing, and dynamic steps of nursing process

1. Assessment of behaviour--- exploration of behaviours manifested in the four adaptive modes allows the nurse to achieve an understanding of the current adaptation level and to plan interventions that will promote adaptation. 2. Assessment of stimuli-------the nurse analyzes subjective and objective behaviours and looks more deeply for possible causes of a particular set of behaviours.

3. Nursing diagnosis-------------Ram defines it as a judgment process resulting in statements conveying the adaptation status of the human adaptive system
4. Goal setting---------------------focuses on promoting adaptive behaviours.

5. Intervention--------------------intervention focuses on the manner in which goals are attained. Nursing intervention is any action taken by a professional nurse that he or she believes will promote adaptive behaviour by a client. 6. Evaluation---------------------has the person moved toward adaptation? Evaluation requires that analysis and judgment be made to determine whether those behavioural changes stated in the goal statement have been achieved or not by the recipient of nursing care.

Figure 1 Person as an adaptive system

Figure 2 Diagrammatic representation of human adaptive systems

METAPARADIGM
PERSON - an adaptive system with coping process -described as a whole comprised of parts -functions as a unity for some purpose -includes people as individual or in groups -an adaptive system with cognator and regulator subsystem acting to maintain adaptation in four adaptive modes HEALTH - the state and process of being and becoming integrated and whole that reflects person and environmental mutuality ENVIRONMENT all conditions, circumstances, and influences surrounding and affecting the development and behaviour of persons and groups with particular consideration of mutuality of person and earth resources NURSING -health care profession that focuses on human life processes and patterns and emphasizes promotion of health for individuals, families, groups, and society as a whole is the science and practice that expands adaptive abilities and enhances person and environment transformation -goal of nursing is the promotion of adaptation for individuals and groups in each of the four adaptive modes thus contributing to health,

APPLICATION OF THE THEORY

Roys model is useful for nursing practice, because it outlines the features of the discipline and provides direction for practice, education, and research. It is a valuable theory for nursing practice, because it includes a goal that is specified as the aim for activity and prescription for activities to realize the goal. With use of Roys six-step nursing process, the nurse performs the following six functions:

By manipulating the stimuli and not the patient, the nurse enhances the interaction of the person with their environment, thereby promoting health.

The Roy Adaptation Model defines the distinct purpose of nursing for students, which is to promote adaptation of persons in each of the adaptive modes in situation of health and illness. The model also distinguishes nursing science from medical science by having the content of these areas taught in separate courses. She views the model as a valuable tool to analyze the distinction between the two professions of nursing and medicine. The adaptation model has been useful in the educational setting and had guided nursing education at Mount Saint Marys College Department of Nursing in Los Angeles since 1970.

Roy has stated that theory development and the testing of developed theories are the highest priorities for nursing. The model has been used extensively to guide knowledge development through nursing research. Roy has identified a set of concepts forming a model from which the process of observation and classification of facts would lead to postulates.

Case Study

A 23-year-old male patient is admitted with a fracture of C6 and C7 that has resulted in quadriplegia. He was injured during a football game at the university where he is currently a senior. His career as quarterback had been very promising. At the time of the injury, contract negotiations were in progress with the leading professional football team.

1. Use Roys criteria to identify focal and contextual stimuli for each of the four adaptive modes. 2. Consider what adaptations would be necessary in each of the following four adaptive modes: physiological, self-concept, interdependence and role function. 3. Create an intervention for each of the adaptive modes that will promote adaptation.