The History of the Roy Adaptation Model

The History of the Roy Adaptation Model

The Roy Adaptation Model for Nursing had it's beginning with Sister Callista Roy entered the masters program in pediatric nursing at the University of California in Los Angeles in 1964. Dorothy E. Johnson, Roy's advisor and seminar faculty, was speaking at the time on the need to define the goal of nursing as a way of focusing the development of knowledge for practice. During Roy's first seminar in pediatric nursing, she proposed that the goal of nursing was promoting patient adaptation. Johnson encouraged her to develop her concept of adaptation as a framework for nursing, throughout the course of her master's program. Von Vertalanffy's use of systems theory was a key component in the early concept of the model, as was the work of Helson. Helson defined adaptation as the process of responding positively to environmental changes, and then went on to describe three types of stimuli, those being focal, contextual, and residual. Roy made derivations of these concepts for use in describing situations of people in both health and illness. Roy's view of the person as an adaptive system took shape from this early work, with the congnator and regulator being added as the major internal processes of the adapting person.

After 17 years of work with the 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 models were added as the ways in which adaptation is manifested and thus as the basis for nursing assessment.

Through curriculum consultation and throughout the USA and eventually worldwide, Roy received input on the use of the model in education and practice. It is estimated that by 1987 at least 100,000 nurses had been educated in programs built around the Roy Adaptation Model. As the discipline of nursing grew in articulating it's scientific and philosophical assumptions, Roy also articulated her assumptions. Roy's first descriptions included systems theory and adaptation-level theory, as well as humanist values. As time progressed, Roy developed the philosophical assumptions 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.

It was during the late 90's that Roy felt she should re-define adaptation for the 21st century. She related spirituality and science to present a new definition of adaptation and related scientific and philosophical assumptions. Roy's stance on the philosophy emphasizes that nurses see persons as co-extensive with their physical and social environments. 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 include: expanding the adaptive modes to include relational persons as well as individual persons and describing adaptation on three levels of integrated life processes, compensatory processes, and compromised processes. Roy has also outlined a structure for nursing knowledge development based on the Roy Adaptation Model and provided examples of research within this structure. Roy remains committed to developing knowledge for nursing practice and continually updating the Roy Model as a basis for this knowledge development.

Person

Roy defines the person as an adaptive open system. The systems' input is: A) Three classes of stimuli: focal, contextual, and residual, within and without the system and B) the systems' adaptation level or range of stimuli in which responses will be adaptive. Inputs are mediated by the systems' Regulator and Cognator subsystems. The system runs into difficulty when coping activity is inadequate as a result of need deficits or excesses. System effectors are the four modes that the Cognator and Regulator can demonstrate activity through. Output of the person as the system may be adaptive or ineffective. Adaptive responses contribute to the goals of the system ie: survival, growth promotion, reproduction and self-mastery. Ineffective responses do not contribute to the systems' goals.

Health

Roy's original model says that health is on a health-illness continuum from wellness to death. The degree of health or illness that the system experiences is an inevitable dimension of a person's life. Currently, Roy defines Health as a process of becoming an integrated and whole person and a process of being. Health is the goal of the person's behavior and the person's ability to be an adaptive organism. Adaptation is a process of responding positively to environmental changes. The person encounters adaptation problems in a changing environment especially in situations of health and illness. Adaptive responses to pooled effects of focal, contextual, and residual stimuli are either positive ie: promote integrity of the system , goals of survival, growth, reproduction and self mastery, or are ineffective.

Environment

The environment of a person constantly interacts with the individual and determines, in part, adaptation level. Stimuli originate in the environment. The environment refers to all the internal/external conditions, circumstances and influences affecting the person, and his development and behavior.

The internal and external environment provide input or stimuli. The environment is always changing and interacting with the person. The stimuli are divided into focal; contextual, and residual categories. Focal stimuli immediately confronts the adaptive system. Contextual stimuli or "background stimuli" is genetic makeup, sex, maturity, drugs, alcohol, etc. Residual stimuli are beliefs, attitudes, experiences, traits which may be relevant but effects are indeterminate and therefore cannot be validated.

Nursing

According to Roy, the Nurse using the Nursing Process, promotes adaptation responses during health and illness to free energy from ineffective or inadequate responses to increase health and wellness. Goals, mutually agreed on and prioritized, are proposed to meet the global goals