1. ROY ADAPTATION MODEL
Presented by :
Ola Al-Omoush
Instructor: Dr. Ghadah Abu- Shosha
Zarqa University
Faculty of Nursing
Course title:
Nursing Theories: Development and Application
2. Objective:
At the end of this lecture the student will be able to :
-Summarize an overview about Dr. Roy background
& credential.
- Identify the theoretical source of RAM.
-Identify and define the major concepts of Roy
adaptation model ( RAM)
-understand the assumptions and proposition of
RAM .
-Paraphrase Meta-paradigm of the theory.
-Learn how Callista RAM can be utilize in the nursing
scopes (practice , education & research).
3. At the end of this lecture the student will be able
to :
-Criticize the theory.
-Determined the strengths and limitations of RAM.
-Discuss a case study and research article that
utilized RAM.
4. Why we choose Roy Adaptation Model
(RAM)?
because ( RAM ) had a strong emphasis on the
patients and their interactions with the
environment.
5. Credentials & Background of the Theorist
-Sister Callista Roy, a member of the Sisters of Saint
Joseph of Carondelet, was born on October 14, 1939,
in Los Angeles, California.
.
6. Timeline of education
level:
Bachelors’ degree in nursing 1963
Masters’ degree in nursing 1966
Began in sociology education
Receiving 2ed masters’ degree in
sociology 1973
Doctorate degree in sociology1977
the rank of professor in 1983
7. Professional Experience
-Pediatric Nurse
-Nursing instructor in many different capacities
-Teaching both pediatric and maternity nursing at Mary's
College in 1966.
-She has lectured across the United States and in more
than thirty other countries
-She organized course content according to a view of
person and family as adaptive systems.
-She introduced her ideas about ‘Adaptation Nursing’ as
the basis for an integrated nursing curriculum.
-She has published many works in (2002),(2008),(2009).
8. Honors and awards
2006
• Distinguished Teaching Award, Boston
College
2007
• Living Legend, American Academy of
Nursing
2010
• Inductee, Sigma Theta Tau’ Nurse
Researcher Hall of Fame
2011
• Mentor Award, Sigma Theta Tau Society
9. The Theoretical source:
•
.
Roy was challenged in a seminar with Dorothy E. Johnson
to develop a conceptual model for nursing.1963
While working as a pediatric staff nurse, Roy had noticed
the children ability to adapt in response to environment change.
Roy developed the basic concepts of the model,
from 1964 to 1966.
Roy was impressed by adaptation as an
appropriate conceptual framework for nursing
10. Roy began operationalizing her model in 1968
Roy combined Helson’s work with Rapoport’s definition of system
to view the person as an adaptive system
Roy (1970) developed and further refined the model with concepts
and theory from Dohrenwend, Lazarus, Mechanic,and Selye.
Roy presented the model as a curriculum framework to a large
audience at the 1977 Nurse Educator Conference in Chicago
11. Introduction to the Roy model
-The Roy adaptation model presents the person as holistic
adaptive system in constant interaction with the internal
and external environmental, the main task of the human
system is to maintain integrity in the face of environmental
stimuli.
-According to Roy ,adaptation refers to “the process and
outcome whereby thinking and feeling person as
individuals or in groups, use conscious awareness and
choice to create human and environmental integration.
12. -The goal of nursing is to foster successful adaptation.
-By Find out demands which are causing problems for the
clients , Assess how well is adapting to them
- Nursing then is directed at helping the client to adopt
13. Adaptation model (major concept)
Stimuli
Coping
mechanism
& process
Adaptation
level &
adaption
mode
Response:
Adaptive
or
Ineffective
response
System
14. Major concept:
A- System
B- input : Stimulus
C- Control process: Coping mechanisms
D- Effector: Physiological function, Self concept, Role
function, Interdependence
E- Output: Adaptive or Ineffective response
15. A- System
A system is “a set of parts connected to function as a
whole for some purpose and that does so by virtue of
the interdependence of its parts”.
(Roy & Andrews,1999, p. 32)
16. B- Input - Stimulus
is something which causes a response. It is an input to a
person's senses which causes a reaction or response.
A stimulus is any factor that provokes a response. Stimuli
may arise from the internal or the external environment
(Roy, 1984).
17. Type of stimulus:
1-The focal stimulus is “the internal or external stimulus
most immediately confronting the human system”
2-contextual stimuli are “all the environmental factors that
present to the person from within or without but which are
not the center of the person’s attention and/or energy”
3-Residual stimuli “are environmental factors within or
without the human system with effects in the current
situation that are unclear”
(Roy & Andrews,1999, p.9,31,32)
18. C- Control process:
Coping process & Coping mechanism
Coping :
“are innate or acquired ways of interacting with the changing
environment”
(Roy & Andrews, 1999, p. 46)
.
19. Coping process:
1- Regulator is “a major coping process involving the
neural, chemical, and endocrine systems”
(Roy & Andrews, 1999, p. 32).
2- Cognator is “a major coping process involving four
cognitive-emotive channels: perceptual and information
processing, learning, judgment, and emotion”
(Roy & Andrews, 1999, p. 31).
20. Coping mechanisms:
1-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” .
2-Acquired coping mechanisms “are developed through
strategies such as learning. The experiences encountered
throughout life contribute to customary responses
to particular stimuli”
(Roy & Andrews, 1999, p. 46)
21. E- EFFECTOR :
Adaptation level & adaption mode
Adaptation is the physical or behavioral characteristic of an
organism that helps an organism to survive better in the
surrounding environment.
22. Adaptation Level
“Adaptation level represents the condition of the
life processes and its affects the individual's ability to
respond positively to a situation described on three levels
as integrated, compensatory, and compromised”
(Roy & Andrews,1999, p. 30).
23. There are three levels of adaptation:
1-Integrated: refers to the structure and functions of life
processes, working as a whole to meet human needs.
2-Compensatory: at this level, the regulatory and cognator
coping subsystems have been activated to respond to
threats or challenges from integrated processes.
3-Compromised: occurs when the above processes are
insufficient, generating an adaptation problem.
24. Adaptive modes:
1- The physiological physical mode.
2- Self-Concept-Group Identity Mode.
3- Role Function Mode.
4-Interdependence Mode.
25. 1- The physiological physical mode :
-The physiological mode “is associated with the physical
and chemical processes involved in the function and
activities of living organisms”. Basic needs:
oxygenation, nutrition, elimination, activity and rest, and
protection.
-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”. Basic needs:
is operating integrity.
26. 2- Self-Concept-Group Identity Mode
“it focuses specifically 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”
Its components include the following:
(1) the physical self, which involves sensation and body image.
(2) the personal self, which is made up of self-consistency, self-
ideal or expectancy, and the moral-ethical-spiritual self
27. **The group identity mode “reflects how people in groups
perceive themselves based on environmental feedback.
:
Composed of
-interpersonal relationships
-group self-image
-social milieu
-culture.
The basic need of the group identity mode is identity
Integrity.
(Roy & Andrews, 1999, p. 107-108).
28. 3-Role Function Mode
is one of two social modes and focuses on the roles the
person occupies in society.
A role, as the functioning unit of society, is defined as a set
of expectations about how a person occupying one position
behaves toward a person occupying another position.
The basic need has been identified as social integrity—the
need to know who one is in relation to others so that one
can act.
29. 4-Interdependence Mode
“The interdependence mode focuses on close relationships
of people and their purpose, structure, and development”
“Interdependent relationships involve the willingness and
ability to give to others and accept from them aspects of all
that one has to offer such as love, respect, value, nurturing,
knowledge, skills, commitments, material possessions,
time, and talents”
The basic need of this mode is termed relational integrity.
(Roy & Andrews, 1999, p. 111)
30. D- Output: Response
is a reaction to a question, experience, or some other type
of stimulus
31. Type of responses:
1-Adaptive Responses: Are those “that promote integrity in
terms of the goals of human systems”.
2-Ineffective Responses are those “that do not contribute
to integrity in terms of the goals of the human system”.
(Roy & Andrews, 1999, p. 31).
32. E- Perception
“Perception is the interpretation of a stimulus and the
conscious appreciation of it” (Pollock, 1993, p. 169).
Perception links the regulator with the cognator and
connects the adaptive modes (Rambo, 1983).
33. Assumption
-Assumptions from systems theory and assumptions from
adaptation level theory have been combined into a single
set of scientific assumptions.
-Human adaptive systems are complex and multifaceted
and respond to a myriad of environmental stimuli to
achieve adaptation.
-With their ability to adapt to environmental stimuli, humans
have the capacity to create changes in the environment
(Roy & Andrews, 1999).
34. -Roy combined the assumptions of humanism and veritivity
into a single set of philosophical assumptions.
*Humanism asserts that the person and human experiences
are essential to knowing and valuing, and that they share in
creative power.
*Veritivity affirms the belief in the purpose value, and
meaning of all human life. These scientific
and philosophical assumptions have been refined
for use of the model in the twenty-first century
35. Explicit assumptions
• The person is a bio-psycho-social being.
• The person is in constant interaction with a changing
environment.
• To cope with a changing world, person uses both
innate and acquired mechanisms which are biological,
psychological and social in origin.
•. To respond positively to environmental changes, the
person must adapt.
36. Explicit assumptions
• The person has 4 modes of adaptation:
physiologic needs, self- concept, role function and
inter-dependence.
• There is a dynamic objective for existence with
ultimate goal of achieving dignity and integrity.
• "Nursing accepts the humanistic approach of valuing
other persons’ opinions, and view points" interpersonal
relations are an integral part of nursing
37. Explicit assumptions
• Health and illness are inevitable dimensions of the
person’s life.
• The person’s adaptation is a function of the stimulus
he is exposed to and his adaptation level
• The person’s adaptation level is such that it
comprises a zone indicating the range of stimulation
that will lead to a positive response.
38. Implicit assumptions
• Nursing is based on causality.
• Patient’s values and opinions are to be considered and
respected.
• A state of adaptation frees an individual’s energy to
respond to other stimuli.
39. PROPOSITIONS—ROY
• Nursing actions promote a person’s adaptive responses.
• Nursing actions can decrease a person’s ineffective
adaptive responses.
• People interact with changing environment in an attempt
to achieve adaptation and health.
• Nursing actions enhance the interaction of persons with
environment.
• Enhanced interactions of persons with environment
promote adaptation.
40.
41.
42. Human ( person)
Person : adaptive system constantly interacting with
external and internal environment.
Based on Roy, humans are holistic beings that are in
constant interaction with their environment. Humans use a
system of adaptation, both innate and acquired, to respond
to the environmental stimuli they experience.
Human systems can be individuals or groups, such as
families, organizations, and the whole global community.
43. Environment
• “The conditions, circumstances and influences
surrounding and affecting the development and
behavior of persons or groups, with particular
consideration of the mutuality of person and
health resources that includes focal, contextual
and residual stimuli.
(Roy and Andrews, 1991)
44. Health
“Health is not freedom from the inevitability of death,
disease, unhappiness, and stress, but the ability to cope
with them in a competent way.”
Health is defined as the state where humans can
continually adapt to stimuli. If human can continue to adapt
holistically, they will be able to maintain health to reach
completeness and unity within themselves. If they cannot
adapt accordingly, the integrity of the person can be
affected negatively
(Roy and Andrews, 1991)
45. Nursing
Defines nursing broadly as a " health care profession that
focuses on human life processes and pattern and
emphasizes promotion of health for individuals , families ,
groups , and society as a whole “.
“The goal of nursing is the promotion of adaptation for
individuals and groups in each of the four adaptive modes,
thus contributing to health, quality of life, and dying with
dignity.”
(Roy and Andrews, 1991)
46. In Adaptation Model, nurses are facilitators of adaptation.
They assess the patient’s behaviors for adaptation,
promote positive adaptation by enhancing environment
interactions and helping patients react positively to stimuli.
Nurses eliminate ineffective coping mechanisms and
eventually lead to better outcomes.
47. Logical Form
The Roy Adaptation Model of nursing is both deductive and
inductive.
It is deductive in that much of Roy’s theory is derived from
Helson’s psychophysics theory. Roy also uses other theory
outside the discipline of nursing .
It is inductive in that she developed the four adaptive modes
from research and nursing practice experiences. Roy built on
the conceptual framework of adaptation and developed a
step-by-step model.
48. Scope of utilization:
:
Practice
Roy adaptation model was recognized as a valuable theory for
nursing practice because it employ all nursing process. .
49. Nursing process related to RAM:
1. Assesses the behaviors manifested from the four adaptive
modes.
2. Assesses the stimuli (focal, contextual, or residual stimulus.
3. Makes a statement or nursing diagnosis of the person’s
adaptive state.
4. Sets goals to promote adaptation.
5. Implements interventions aimed at managing the stimuli to
promote adaptation.
6. Evaluates whether the adaptive goals have been met.
50. Example:
The Roy Adaptation Model has been applied to:
-adult patients with (post-traumatic stress disorder)
-women in menopause
-An elderly man undergoing amputation.
-Adolescents with cancer, Asthma, high-normal or
hypertensive blood pressure readings.
-Death and dying
-Recovery following coronary artery bypass surgery
51. EDUCATION:
• The adaptation model is also useful in educational setting.
The model allow to increase knowledge in both area theory
and practice.
• The Roy Adaptation Model has been used in the
educational setting and has guided nursing education at
Mount Saint Mary’s College Department of Nursing in Los
Angeles since 1970.
• More than 100,000 student nurses had been educated in
nursing programs based on the Roy Adaptation Model in
the United States and abroad
52. RESEARCH
If research is to affect practitioners’ behavior, it must be
directed at testing and retesting conceptual models for
nursing practice. Roy has stated that theory development
and the testing of developed theories are nursing’s highest
priorities. The model must be able to regenerate testable
hypotheses for it to be researchable.
54. CLARITY
• The Meta paradigm concepts of the roy
adaptation model are clearly defined and
consistent.
• Roy clearly defines the four adaptive modes with
minimal unclear boundaries.
-Interrelated by perception.
• Some use of theoretical jargon.
• Good assessment method.
55. SIMPLICITY
This model has several major concepts and sub
concepts, So the relational statements are
complex until The model is learned.
56. COMPLEXITY
• Abstract and difficult to understand
• Concept of person as an adaptive system
• Not easily operational for research
• Stimuli create an extensive list of potential
variables.
57. COMPLETENCES
• Addresses all four concepts of a nursing model.
• Comprehensive and systematic assessment.
• Focus on the individual.
• Person is adaptive system
58. GENRALITY
• The Roy adaptation model’s broad scope is an
advantage because it may be used for theory
building for deriving middle-range theories for
testing in studies .
• Roy’s model is generalizable to all settings in
nursing practice but is limited in scope, as it
primarily addresses the person-environment
adaptation of the patient, and information about
the nurse is implied.
59. ACCESSEPILITY
• Roy’s broad concepts stem from theory in
physiological psychology, psychology, sociology,
and nursing.
• Roy’s model offers direction for researchers who
want to incorporate physiological phenomena in
their studies.
• RAM identified many propositions to serve in the
development of middle-range theory.
60. IMPORTANCE
• The Roy adaptation model has a clearly defined
nursing process and is useful in guiding clinical
practice.
• The utility of the model has been demonstrated
globally by nurses.
62. Strength point:
• Clearly defined nursing process
• Useful in guiding clinical practice
• Accommodates for physical as well as
psychosocial needs
• Patient plays an active role – nurse is a facillator
• Persons values and opinions are considered and
respected
65. CASE STUDY
A 53 years old male patient who was suffering
with diabetes mellitus for past 10 years. He
developed a diabetic foot ulcer and had to
undergo amputation. He was admitted in __
Hospital. Mr. NR was selected for application of
RAM in providing nursing care.
66. 1-ASSESS. OF BEHAVIOUR
Ineffective protection and sense in physical-physiological
mode(No pain sensation from the wound site.)
ASSESSMENT OF STIMULI
Focal stimuli:
Non-healing wound after amputation of great and
second toe of left leg.
NURSING DIAGNOSIS
Impaired skin integrity related to fragility of the skin
secondary to vascular insufficiency
67. GOAL
1-long-term objective:
- Skin will remain intact with no ongoing ulcerations.
2- Short-Term Objective:
- Size of wound
- No signs of infection
INTERVENTION
1-Maintain the wound area clean as contamination affects the
healing process.
2-Follow sterile technique to prevent infection and delay in
healing.
3-Perform wound dressing
4-Monitor for signs and symptoms of infection or delay in healing.
5-Administer the antibiotic
68. 2- ASSESS. OF BEHAVIOUR
-Impaired activity in physical-physiological mode
ASSESSMENT OF STIMULI
Focal stimuli:
-During hospital staying great and second toe amputated.
But surgical wound turned to non- healing with pus and
black color.
NURSING DIAGNOSIS
-Impaired physical mobility related to amputation and
presence of unhealed wound
69. GOAL
1-Long term Objective:
-Patient will attain maximum possible physical mobility
within 6months.
2-Short term objective:
-Correct use of crutches
-walking with minimum support-
INTERVENTION
1-Assess the level of restriction of movement
2-Provide active and passive exercises to all the
extremities to improve the muscle tone and strength.
3-Make the patient to perform the ROM
70. 3-ASSESS. OF BEHAVIOUR
-Alteration in Physical self in Self-concept mode
(He is anxious about changes in body image)
-Change in Role performance mode. (He was the earning
member in the family. His role shift is not compensate)
ASSESSMENT OF STIMULI
Contextual stimuli:
-Known case DM for past 10 years and on treatment with
insulin for 8 years.
Residual stimuli: no special knowledge in health matter.
71. Nursing diagnosis
1-Anxiety related to hospital admission.
Goal
1-Long term Objective:
-The client will remain free from anxiety.
2-Short term objective
-demonstrating appropriate range effective coping in the
treatment .
72. INTERVENTION
1-Allow and encourage the client and family to ask
questions.
2-Allow the client and family to verbalize anxiety.
3- Repeat information as necessary because of the reduced
attention span of the client and family.
4-Provide comfortable quiet environment for the client and
family.
74. References
- Marilyn ,E.and Marlaine,C.(2010).Nursing theories and
(
nursing practice ,3rd (ed).Philadelphia:F.A.Davis .p(83-103
Roy, C., & Andrews, H. A. (1999). The Roy adaptation
model(Vol. 2). Stamford, CT: Appleton & Lange. Chicago
Roy, S. C. (1984). Introduction to nursing: An adaptation
model (Vol. 84, No. 10, p. 1331). LWW.
