this theory can help the nurses to find out the cause the patient uncertain and nurse takes action to enable the patient to cope with the situation.

1. Presented by
Sehrish Naz
MSN year 1, Semester 1
Facilitator
Sir Dildar Muhammad
Assistant Professor INS KMU
12/6/2017 1

2. Grand theories based on interactive process
• Nursing theories that focused on interactions between the client and the nurse
and between the client and the health care system.
• In the interaction models and theories, human beings are viewed as interacting
wholes and client problems are seen as multifactorial.
• Interactions between clients and their environments, both internal and external,
some of which cannot be measured.
• The interactive theories are need theories and grounded in the postpositive
schools of philosophy.
(McEwen, Willis, 2011)
12/6/2017 2

3. Outlines
• Get a brief introduction of theorist.
• Define the theory and metaparadigm.
• Explain the internal processing subsystems.
• Describe the types of stimuli.
• To know the adaptive modes.
• Is the theory applicable.
• Is the theory practicable.
• Can the theory guide research studies.
• Can the theory used in educational programs.
12/6/2017 3

4. Dr. Callista Roy
• Born in Los Angeles, California on October 14, 1939.
• Designated as a 2007 living legend by the American Academy of
Nursing.
• Master in Pediatric Nursing from University of California in 1966.
• Second Master and PhD in Sociology in 1973-1977.
12/6/2017 4

5. Cont...
• Dr. Roy also had the opportunity to be a Clinical Nurse Scholar two
year Post-Doctoral program in Neuroscience at University of
California. She selected this field to develop her understanding of the
holistic person, especially as an adaptive system. And because of her
familiarity with this clinical area because of her own neurological
illnesses.
12/6/2017 5

6. Professional Experience
• Nurse Aid at the age of 14.
• Pediatric Nurse.
• Nursing Instructor in many different capacities.
• She has lectured across the United States and in then thirty other
countries.
• Currently she is studying the role of lay study in recovery from mild head
injury.
12/6/2017 6

7. 12/6/2017 7

8. Introduction to the Model/Theory
Adaptation was first introduced to Dr. Roy in her psychology class.
Adaptation of children:
While working as a Pediatric nurse, Roy had noticed the great resiliency
of children and their ability to adapt in response to major physical and
psychological changes.
Theory development started in 1964.
12/6/2017 8

9. 12/6/2017 9

10. Statement Of The Theory
“The goal of nursing is to promote adaptation
for individuals and groups in each of the four
adaptive modes i.e. physiological needs, self-
concepts, role function, and interdependent
relations thus contributing to health quality of
life, and dignity with dying”.
12/6/2017 10

11. The Roy Adaptation Model
• The Roy Adaptation Model (RAM) focuses
on the interrelatedness of four adaptive
systems.
• It is a deductive theory based on nursing
practice.
• The RAM guides the nurse who is
interested in physiologic adaptation as
well as the nurse who is interested in
psychosocial adaptation.
(McEwen, Willis, 2011)
12/6/2017 11

12. 12/6/2017 12

13. Person
• The person (or a group) viewed as an adaptive system, their
health and their environment.
• Person also refers to families, groups, communities and the
whole society.
12/6/2017 13
(Roy, C, 2009)

14. Health
• Health is the state and the process of being and becoming an
integrated and whole person.
• It is a process of where he or she is striving to achieve their maximum
potential.
( Roy,C ,2009)
12/6/2017 14

15. Environment
• Roy’s sees the environment as all
conditions, circumstances and influences
that surround and affect the development
and behavior of the person.
• A change acts as a stimulating and causes
adaptive responses.
Roy .C, 2009)12/6/2017 15

16. Nursing
• Nursing acts to enhance the interaction of
the person with the environment to promote
adaptation.
Roy, C.,(2009)
12/6/2017 16

17. Coping Subsystems
12/6/2017 17

18. •Regulator – subsystem coping mechanism which responds
automatically through neural-chemical-endocrine processes.
•Cognator - subsystem coping mechanism which responds to
complex processes of perception and information processing,
judgment, and emotion.
These subsystems are the mechanisms used by human beings to cope
with stimuli from the internal and external environment.
12/6/2017 18Rambo 1984

19. 12/6/2017 19

20. • Adaptation Level is a constantly changing point, made up of focal,
contextual and residual stimuli, influence the individual’s ability to cope
with the environment.
12/6/2017 20
Rambo 1984
Cont,..

21. Cont…
• Focal stimuli: that immediately confront the individual in a particular
situation.
• Contextual stimuli: are those other stimuli that influence the situation.
• Residual stimuli: include the individual’s beliefs or attitudes that may
influence the situation.
(Rambo 1984)
12/6/2017 21

22. Examples of types of Stimuli
Example: Smoking
Focal: Nicotine Addiction.
Contextual: Belief that smoking is enjoyable, relaxing, part of
routine.
Residual: Belief about body image with smoking cessation.
12/6/2017 22

23. Responses
12/6/2017 23

24.  Adaptive Responses – responses that promote integrity of the
person in terms of goals of survival, growth, reproduction, and
mastery.
 Ineffective Responses – responses that do not contribute to
adaptive goals.

25. Adaptive modes
• Physiological: oxygenation, nutrition and elimination, activity, rest and
protection.
• Self-Concept: Psychological and spiritual elements.
• Role Function: Primary, secondary and tertiary roles the person performs in the
society.
• Interdependence: Coping mechanism arising from close relationships.
• Goal: promote integrated adaptation in all four modes= Health.
12/6/2017 25

26. 12/6/2017 26

27. Roy’s Model(A system model)
• Roy’s model is a system model that focuses on outcomes.
• The major features of the system models are the system and its environment
• A system is a set of parts connects to function as a whole for some purposes
and are interdependence of its parts.
• A system is characterized by inputs, outputs, control and feedback processes.
12/6/2017 27

28. 12/6/2017 28

29. 12/6/2017 29

30. Case study(hypothetical)
• Mr.NR 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. He is conscious and oriented. He is anxious
about the disease condition. Like to go home as early as possible.
Showing signs of stress. Touch and pain sensation decreased in lower
extremity. Thinking and memory is intact. Mr. NR was selected for
application of RAM in providing nursing care.
12/6/2017 30

31. 1. Assessment of behaviors
• Alteration in Physical and 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.
Matt Vera, 201412/6/2017 31

32. 2. 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 matters
12/6/2017 32

33. 3. Nursing diagnosis
Anxiety related to hospital admission and unknown Outcome of the
disease and financial constraints.
Matt Vera, 2014
12/6/2017 33

34. 4. Goal settings
Long term Objective:
The client will remain free from anxiety
Short term objective:
i. Demonstrating appropriate range effective coping in the treatment
ii. Being able to rest and
iii. Asking fewer questions
Matt Vera, 2014
12/6/2017 34

35. 5. Intervention
Allow and encourage the client and family to ask questions. Bring up
common concerns.
- Allow the client and family to verbalize anxiety.
- Stress that frequent assessment are routine and do not necessarily imply
a deteriorating condition.
- Repeat information as necessary because of the reduced attention span
of the client and family
Matt Vera, 201412/6/2017 35

36. 6. Evaluation
Short term goal:
Met: demonstrated appropriate range effective coping with treatment
He is able to rest quietly.
Long term goal:
Unmet: client not completely remained free from anxiety due to
financial constrains- Continue plan Reassess goal and interventions
Matt Vera, 2014
12/6/2017 36

37. Roy’s Adaptation Model Cont..
• A total of 163 studies were conducted by the group of
seven scholars to test the proposition of the model.
• Has been in use for more than 49 years in providing
direction for nursing practice, education,
administration and research.
• Internationally used.
Alligood M.R Ann Marriner(2010)
12/6/2017 37

38. 12/6/2017 38

39. 12/6/2017 39

40. 12/6/2017 40

41. 12/6/2017 41

42. 12/6/2017 42

43. 12/6/2017 43

44. 12/6/2017 44

45. 12/6/2017 45

46. 12/6/2017 46

47. 12/6/2017 47

48. 12/6/2017 48

49. 12/6/2017 49

50. 12/6/2017 50