Modern researchers aim at improving an understanding of nursing and the role of this practice in society. Many models and theories have already been created, focusing on multiple perspectives. In 1976, Sister Callista Roy presented her Adaptation Model and explained nursing as a social service. Humans may be considered individuals or group members, introducing human adaptive systems to complete certain processes and maintain adaptation through the prism of specific modes. Roy’s model is based on four adaptive modes, namely physiological, self-concept, role function, and interdependence (Roy, 1999). In this paper, the analysis of the Roy Adaptation Model will be developed with respect to its background, essentials, and worldview. The incorporation of four nursing metaparadigm concepts and Carper’s ways of knowledge should help comprehend the model. The evaluation of the model on the basis of Parse’s criteria and Carper’s ways of knowledge will show the weak and strong aspects of Roy’s work. Roy Adaptation Model is one of the most commonly used models in nursing to evaluate patients, increase compliance, and improve care quality, making it efficient for registered nurses.
Background
Roy is an American nun and a nursing theorist, with several degrees in nursing and sociology. In the 1960s, she worked with Dorothy E. Johnson and contributed to creating a conceptual nursing model, but her interest was directed to adaptation resiliency among children (Phillips & Harris, 2018). In 1970, Roy introduced the model to apply a conceptual path to understanding human behaviors (Roy & Andrews, 1999). As soon as nurses started viewing human beings as adaptive systems, it became easier to assess behaviors and stimuli, make nursing diagnoses, set goals, or promote interventions and evaluations (Roy & Andrews, 1999). The environment always undergoes a number of significant changes, and people should be ready to recognize, accept, and develop appropriate reactions. According to Newman and Leininger (as cited in Roy & Andrews, 1999), health awareness must be grounded in personal experiences, and nursing care is determined by cultural accommodations and professional knowledge. Before Roy, no steps to combine the concepts of the environment and human adaptation abilities were made; therefore, this model is a necessary point in nursing development.
Description
In nursing practice, the staff needs to know how to support patients and their families in adapting their behaviors. Roy paid attention to the impact of scientific and philosophical assumptions. The scientific aspect is grounded on the works by von Bertalanffy (general systems) and Helson (adaptation-level theory) and includes the principles of holism, control, feedback, and processes (Phillips & Harris, 2018; Roy & Andrews, 1999). The philosophical perspective touches upon the concepts of humanism and veritivity (Roy & Andrews, 1999). One of Roy’s main thoughts was the importance of religious faith in healing and well-being, but she tried to find another way to investigate human existence. To be rational, people should develop value-based, purposeful, and related behaviors, which are the main characteristics of creativity.
Roy’s model proves that people have to be in constant interaction with the environment. During this process, the exchange of information occurs, predetermining available resources and knowledge. Regarding the offered assumptions, humans are decision-makers, and the creativity of their actions depends on how well they may co-exist within the offered situation. Conscious awareness plays a vital role in patients’ possibilities to respond positively to changes and behave following the standards (Roy & Andrews, 1999). Roy underlines the role of God and the development of mutual relationships. People possess enough skills to sustain and transform the environment as per their needs. Their beliefs and attitudes toward each other and the environment have to be recognized to take correct self-care steps and cooperate with nurses.
Concepts
The Adaptation Model of Nursing contributes to a sufficient explanation of nursing science and an individual as an interrelated (adaptive) system to balance stimuli and processes. The discussion of humans as adaptive systems includes stimuli and their possibility to make up the adaptation level as an internal input. The model also conceptualizes the dynamics between an individual and the coping processes, categorized into the regulator and cognate subsystems. Each subsystem is characterized by four specific modes with the help of which people formulate their behaviors and expectations in relation to the environment, health, and nursing.
Stimuli. There are three types of stimuli in the chosen model (Roy & Andrews, 1999). First, the focal stimulus covers internal and external factors that confront the human system (e.g., pain, fever, fear, or anxiety). Second, the contextual stimulus is associated with other situational factors that may influence focal stimuli (e.g., poor awareness of a situation or lack of supportive objects). Third, the residual stimulus includes the environmental factors, the impact of which remains unclear in the situation (e.g., past experience or neglected memories). Roy and Andrews (1999) underline that due to a constantly changing environment, many stimuli cannot become focal, and the human system fails to recognize them. Therefore, when nurses use the Roy Adaptation Model to view a patient, stimuli like positive or negative environmental changes are noted as focal. When focal stimuli are defined, it is easier to differentiate contextual stimuli because they make some contributions with time and facilitate adverse outcomes. Identifying residual stimuli, nurses rely on their intuitive impressions after communication with patients and personal observations.
Adaptation level. According to Roy’s model, the adaption level is also defined as a stimulus. Although this concept has been briefly reviewed in previous models and theories, Roy explains its importance to the human system and the ability to respond to a real-life situation at three levels (Roy & Andrews, 1999). The integrated adaptation level focuses on the structures and functions of processes to meet human needs. The compensatory adaptation level is observed when the system’s integrated processes are activated in response to challenges. The compromised adaptation level is necessary when the system does not work correctly at the previous levels, and nurses have to find another effective solution to protect human life.
Behavior. The assessment of patients’ behaviors is an integral task for nursing within the Roy Adaptation Model. The theorist defines behavior as a person’s reaction (internal and external actions) under a specific condition. If stimuli and adaptation levels are considered inputs in the human system, behavior turns out to be the main output. If the responses promote integrity and meet the goals of well-being, they are called adaptive. If no integrity or positive contributions is observed, such responses are defined as ineffective, and new adaptation methods should be discussed.
Coping processes. People possess a list of innate skills, and coping processes are the qualities that define human development. These processes are usually automatic because people do not think about how to react but do everything instinctively and unconsciously. The regulator subsystem is developed on physiological mechanisms, including neural, chemical, and endocrine channels (Roy & Andrews, 1999). The cognate subsystem covers mental mechanisms and activates cognitive-emotional channels in the brain to learn, perceive, and interpret information.
Adaptive modes. As Roy’s model states, the goal of nursing is the promotion of adaptation for patients in regard to four adaptive modes. The physiological-physical model is developed on the basis of five basic human needs – oxygenation, nutrition, elimination, activity/rest, and protection (Phillips & Harris, 2018). The self-concept mode implies the importance of spiritual and emotional integrity to create a strong body image and determine personal ideals. The role function mode helps define the roles that a person has to perform in society as an integral member. The interdependence model focuses on people’s relationships and understanding their purposes and development, following the principles of respect, love, and commitment.
World View
Taking into consideration the main concepts and assumptions of the theory, its world view promotes reciprocal interaction. Roy underlines the necessity to apply a holistic view for individuals to represent them as adaptive systems that have to respond with appropriate stimuli, behaviors, and modes. This model views each individual as a part of the system, the purpose of which is to unite diverse skills within a changing environment (Roy & Andrews, 1999). Sometimes, it is easy to categorize a stimulus and choose the correct way of adaptation. Sometimes, nurses need more time to investigate a situation and understand what steps are beneficial for their patients.
Diagram
As it is shown in Figure 1, the Roy Adaptation Model is characterized by one input that is represented by specific stimuli and several outputs (behaviors) that depend on individual characteristics and nursing goals. The process of adaptation is determined by four main coping processes (physiological-physical, self-concept, role function, and interdependence). This diagram proves that Roy does not prioritize coping processes, and it is possible to start with any process, relying on personal needs, knowledge, and experiences.
Evaluation of the Model
Parse Criteria
In modern nursing, several criteria exist to evaluate theories and models. Nurses and students use them to understand the shortages and benefits of the chosen frameworks and apply them successfully. In many cases, the authors of such criteria try to develop their works broadly enough, so all structures and processes may be analyzed. In 1987, Rosemarie Rizzo Parse introduced new criteria for the evaluation of nursing theories, the appraisal of which was divided into structure and process. Structure criteria consist of historical evolution (developmental details and antecedents), foundational elements (assumptions and concepts), and relational statements (principles and description) (Parse, 2012). Process criteria include correspondence, coherence, and pragmatics of the model. Semantic integrity (meaningful consistency) and simplicity (uncluttered abstract descriptions) are referred to as correspondence (Parse, 2012). The elements of coherence are syntax (ideas’ precision) and aesthetics (presentation quality). Pragmatics is used to cover the effectiveness of the model (practical worth) and its heuristic potential (further inquiry). As Parse’s criteria are directed to all human-universe-health process perspectives, its application for Roy’s model of adaptation can be justified.
Criteria Evaluation Using Parse
In terms of its historical evaluation, the Roy Adaptation Model was developed by Callista Roy in 1970 to help people, defined as adaptive systems, cope with stimuli, develop certain processes, and respond to the environment. Several theories, including general systems and adaptation-level (psychophysics) theory, are the theoretical antecedents, while humanism and veritivity are philosophical assumptions. No significant changes were made since the first publication of the model. Philosophical and major concepts are explicitly stated and related to the human-universe-health process through the four modes and the role of God in human relationships. The general principles of human creativity and cosmic unity are the major characteristics of Roy’s philosophical thoughts to prove the purposefulness of human behaviors (Jennings, 2017). They properly reflect the basic concepts of person, health, the environment, and nursing due to the relation between people and the earth.
All the meanings of concepts and processes are thoroughly described by Roy, following consistency, which tells about the model’s semantic integrity. All definitions and examples are abstract, with no complex situations, which prove simplicity. There are a logical flow and symmetrical structure of the model, proving its coherence. Finally, many authors use Roy’s model in their analyses and improvements of nursing processes (Callis, 2020; Jennings, 2017; Salazar-Barajas et al., 2018). The heuristic potential is evident because Roy’s a constantly changing environment as one of its basic principles. The same model can be appropriate for current nursing practice or future studies because its idea lies in human skills and stimuli. In general, Roy’s model of adaptation meets the criteria of Parse and proves its effectiveness in making the transition from a registered nurse (RN) to an RN with a graduate degree.
Incorporation
Four Nursing Concepts
The success of any nursing model depends on how well theorists incorporate four major concepts of the nursing metaparadigm that are patient, health, environment, and nursing. In Roy’s model, a patient (or person) is introduced as a holistic, adaptive system (Roy & Andrews, 1999). Unity is a significant characteristic of this system because it enhances the whole work, along with its functions and structures. Human systems are individuals (patients), families, organizations, communities, and even societies that demonstrate thinking and feeling capacities. They become the main focus of nursing as they receive care and develop behaviors.
Health is a process of becoming integrated within a specific system. According to Roy, it is a reflection of adaptation when a person has to interact with the environment (Roy & Andrews, 1999). The environment includes the conditions and situations that might influence human behaviors and decisions. Roy believes that the environment is constantly changing, thus stimulating people to continue their adaptation all the time. Therefore, attention to focal, contextual, and residual stimuli is paid as the factors that could affect a patient. Finally, nursing is not only a professional that emphasizes health promotion but the science or practice that aims at expanding human adaptive abilities (coping processes) (Roy & Andrews, 1999). Nurses should help patients and their families to investigate the environment and promote the cooperation of people within a particular situation.
Carper’s Four Ways of Knowing
In nursing and healthcare, Carper’s ways of knowing are commonly integrated during the evaluation of a model or theory, with the help of which different sources of knowledge are identified. First, there is empirical (factual) knowledge that is scientifically derived and may be empirically verified. The Roy Adaptation Model is based on scientific assumptions like systems theory and adaptation-level theory, which makes it empirically verified. Second, personal knowledge covers self-understanding of a matter like imagination or evaluation. Adaptation means the use of specific coping processes that need the development of personal skills. Third, ethical knowledge implies the necessity of an ethical framework and learning the existing morals and beliefs. Integrated life processes that are described as essential for adaptation entail moral, ethical, and spiritual growth. Fourthly, aesthetic knowledge is important for a particular situation that is happening at the moment. Roy’s approach underlines the changing nature of the environment, which makes it possible for this model to stay aesthetic all the time.
Use in Practice
Model in Academic Research
People face many changes with age, and older adults have to apply modifications to their health behaviors, risk prevention, and social connection. According to Salazar-Barajas (2018), factors like disease period, social support, coping possibilities, health perception, or mental problems may contribute to active aging. The application of Roy’s model is an effective method to identify the expected outcomes (adaptation) like independence, good mental state, and symptoms’ absence. Chronic diseases and socio-demographic factors (age or gender) are the stimuli that influence coping processes. Social support and volunteering are solutions for older adults in promoting active aging. Roy’s theory guided the research by Salazar-Barajas (2018) in a variety of ways, specifying primary, secondary, and tertiary roles of patients and nurses. Hope, time, and knowledge are crucial in nursing care that is offered to older adults.
Current Practice
In current professional practice, Roy’s model is characterized by many benefits because it is both a science and a philosophy. The responsibilities of RNs include monitoring and educating patients, administrating medications, and promoting consultations with healthcare providers. Cooperation with people means gathering and analyzing information quickly, and the Roy Adaptation Model may become a helpful framework. Instead of specifying patients’ needs, RNs use this model to recognize their stimuli (internal and external factors) and combine them with skills and possibilities (coping processes) to achieve the best results (successful adaptation). The application of Roy’s model provides a better understanding of adaptive strategies within the environment (Jennings, 2017). An RN is also an adaptive system with distinct holistic characteristics and can be affected by different factors (Callis, 2020). The adaptation model categorizes the duties of RNs to meet their own needs and the expectations of patients.
Future Practice
When an RN gets a graduate degree, the scope of responsibilities and possibilities is enlarged. New options for me as an RN mean new obligations and knowledge, and Roy’s model is a chance to differentiate tasks and get adapted to new working conditions. This framework will guide my future practice in many ways. For example, I will add new inputs (stimuli) regularly and choose between the coping processes in a constantly changing adaptive environment. RNs with degrees should not re-evaluate their duties from scratch during their transition but add new factors and decide what outcomes (behaviors) to apply. The model also facilitates the cooperation of RNs with doctors and patients as it offers a clear plan on how to obtain information and interpret it within a specific situation.
Conclusion
Roy’s adaptation model consists of several essentials, and each of them should be properly identified and explained to get a clear idea of this theorist’s work. The benefits of this model for nurses include the possibility of dealing with multi-faceted individuals and studying the influences of different factors. The flow of actions is logical and strengthens the unity of ideas and decisions. There are no complex terms in the model, and RNs learn how to observe and communicate, following individual norms and integrity principles. However, some nurses may be confused by many elements and concepts and lose their ways with all those stimuli, subsystems, and adaptive modes. I will use the diagram as a theoretical base that assists in transitioning from an RN to an RN with a graduate degree. The model shows what factors to consider, how to cope with challenges, and how to adapt to a new environment within a short period. Nurses are obliged to deal with various tasks and work with different people; thus, Roy’s adaptation model is necessary to identify and explicate this heterogeneity and make correct decisions.
References
Callis, A. M. B. (2020). Application of the Roy adaptation theory to a care program for nurses. Applied Nursing Research. Web.
Jennings, K. M. (2017). The Roy adaptation model: A theoretical framework for nurses providing care to individuals with anorexia nervosa. Advances in Nursing Science, 40(4), 370 – 383. Web.
Parse, R. R. (2012). Parse’s criteria for evaluation of theory with a comparison of Fawcett’s and Parse’s approaches. In P. G. Reed & N. B. C. Shearer (Eds.), Perspectives on nursing theory (6th ed.) (pp. 358-360). Wolters Kluwer Health.
Phillips, K. D., & Harris, R. (2018). Sister Callista Roy: Adaptation model. In M. Alligood (Ed.), Nursing theorists and their work (6th ed.) (pp. 249-272). Elsevier Health Sciences.
Roy, C., & Andrews, H. A. (1999). The Roy adaptation model (2nd ed.). Appleton & Lange.
Salazar-Barajas, M., Crespo, M. L., Cortez, P. L. H., Reyna, M. A. V., Cabriales, E. C. G., Meza, M. V. G., & Gonzalez, B. C. S. (2018). Factors contributing to active aging in older adults, from the framework of Roy’s adaptation model. Investigación y Educación En EnfermerÃa, 36(2). Web.