The Roy Adaptation Model (RAM) was developed by Sister Callista Roy, a nurse theorist best known for creating this theoretical approach to nursing. RAM views the person as an adaptive system that responds to environmental changes. The four main concepts in RAM are the person, environment, health, and nursing. The goal of nursing according to RAM is to promote the person's adaptation. Nurses assess a person's adaptive abilities and develop plans to help them positively adapt to their environment in order to achieve health, quality of life, and dignity.

1. Sister Callista Roy RN, Ph.D., is a nurse theorist, college professor, researcher,
writer, and lecturer. She is best known for the development of the Roy
Adaptation Model (RAM). RAM is a theoretical approach to nursing and is widely
used in nursing practice, education, and research. One of her core values is the
belief in the basic human good of people.
Callista Roy was born on October 14, 1939 in Los Angeles, California. She is the 2nd of fourteen
children in her family. During her high school years, she was fortunate to work as a nurse’s aide
at the hospital where her mother worked as a nurse. Upon graduating high school, she entered
the Sister of St. Joseph of Carondelet. Sister Callista Roy received a four-year scholarship to
Mount Saint Mary’s College in Los Angeles, where she received her Bachelor of Arts with a
major in nursing in 1963. She worked one year as a staff nurse in Tucson, Arizona working in
pediatrics. She then started to work on her Master's Degree at UCLA. After receiving her
Master's Degree in pediatric nursing in 1966, Sister Callista Roy returned to her Alma Mater
Mount Saint Mary's College, where she taught on and off for seventeen years. In 1975, she
received a Master's in Sociology from UCLA, followed by her Doctoral Degree in Sociology in
1977. Dr. Roy received one of the very first Postdoctoral Fellowships from the Robert Wood
Johnson Foundation. She conducted her postdoctoral studies at the University of California in
San Francisco focusing on neuroscience nursing. (Alumni UCLA, 2012 UCLA awards; Boston
College, 2013. Featured faculty; UCDenver, 2012. Nurse theorists portraits of excellence)

2. While Sister Callista Roy was working as a pediatric nurse, she noticed how
children were able to adapt to physical and psychological experiences. This led
to her creation of the Roy Adaptation Model. The model gives a path for what
nurses can do to help patients deal with health challenges. The Roy Adaptation
Model was first published in 1970. (Sacred Heart University, 2013. Nursing
grand theory and theorists; Masters, 2012)
Today Dr. Roy is a professor and nurse theorist at Boston College where
she has been for the last twenty-six years. She is also a Faculty Senior
Nurse Scientist at Massachusetts General Hospital. Roy continues to
refine and redefine the Roy Adaptation Model. Dr. Roy has over 130
publications including twelve books, many of which have been
translated into other languages. Roy has presented lectures and
workshops in over thirty countries on topics related to nursing theory,
research curriculum, clinical practice, and professional trends in nursing.
Dr. Roy has received many awards and accolades including:
o Fellow of the American Academy of Nursing
o Named a Living Legend by the American Academy of Nursing
o Inaugural member of the Sigma Theta Tau International Nurse
Researcher Hall of Fame (Alumni UCLA, 2012. UCLA awards; Boston
College, 2013. Featured faculty)

3. The Roy Adaptation Model (RAM) is one of the most applied models in nursing practice, research, and
education today. The central concept of RAM is that the person is an adaptive system that needs to respond
positively to the environmental changes of focal, contextual, and residual stimuli. Dr. Roy proposed that the
goal of nursing was promoting patient adaptation.
Four elements are included in the Roy Adaptation Model: person, nursing, health, and environment. People
are seen as living adaptive systems and their behaviors may be classified as either adaptive responses or
ineffective responses. According to the Roy Adaptation Model, the goal of nursing is to promote adaptive
responses with respect to the four adaptive modes: 1) Physiological/physical, 2) Self-concept/group identity,
3) Role function, and 4) Interdependence. Health is the process of being able to meet the goals of survival,
growth, reproduction, and mastery. The environment is composed of the internal and external stimuli that
exist around an individual. (Boston College, 2013. The Roy adaptation model; Current Nursing, 2012. Roy’s
adaptation model)

4. Person: In nursing care, the main focus is the person who is the recipient of the care. RAM focuses on the
metaparadigm of person as a holistic adaptive system with coping mechanisms manifested by four adaptive
modes: physiologic, self concept, role concept, and interdependence. This system is described as a whole
compromised of parts that functions as a unity for some purpose. It includes people as individuals or in groups
(families, organizations, communities, nations, and society as a whole).
1. Physiologic: The physiologic mode deals with the maintenance of the physical body.
-In the individual, there are five needs:
1. Oxygenation
2. Nutrition
3. Elimination
4. Activity
5. Rest and protection
-There are also four regulatory processes:
1. The senses
2. Fluids and electrolytes
3. Neurologic
4. Endocrine functions
2. Self Concept: The self concept mode deals with the maintenance of the mind. The person's perception of
his or her physical and personal self are included in this mode.
3. Role Function: Roles that individuals occupy in society, fulfilling the need for social integrity such as role
development, instrumental and expressive behaviors, and role taking process. This addresses people's
adaptations to different role changes that occur throughout a lifetime. It is knowing who one is in relation to
others.
4. Interdependence: The close relationships of people and their purpose, structure, and development
individually and in groups. It involves ways of seeking help, affection, and attention. It is the ability to love,
respect, value, and accept. (Boston College, 2013. The Roy adaptation model; Current Nursing, 2012. Roy’s
adaptation model; Masters, 2012)

5. Environment: A person's environment is in constant change. Dr. Roy's model
relates to the metaparadigm of environment in that in order to respond
positively to one's changing environment, they must adapt to all the stimuli they
encounter. The goal of nursing care is to help the patients to adopt positive
responses to the various stimuli of their environment. A patient's environment
includes both internal and external stimuli consisting of all conditions,
circumstances, and influences that surround and affect the development and
behavior of people and groups with particular consideration of mutuality of
person and earth resources. These may be viewed as inputs into the adaptive
model that affect transformation. The environment has three components:
 Focal: Stimuli that is internal or external and immediately confronts the person
 Contextual: All stimuli present in the situation that all contribute to the effect of
the focal stimulus
 Residual: Stimuli whose effects in the current situation are unclear
Nursing should promote adaption interventions to help the patients respond
positively to the stimuli of their environment so as to contribute to their overall
health and quality of life. (Boston College, 2013. The Roy adaptation model;
Current Nursing, 2012. Roy’s adaptation model; Masters, 2012)

6. Health: The Roy Adaptation Model focuses on the metaparadigm of health on
the process and outcome of adaptation. A person's health will be influenced
by his or her adaptive abilities to:
• Inevitable dimension of person's life
• Represented by a health-illness continuum
• A state and a process of being and becoming integrated and whole,
reflecting a person and environment mutuality
Roy wrote about health existing as a continuum in her early writings. However,
she now views this conceptualization of health as “simplistic and unrealistic
since it does not accommodate the existence of wellness and illness, and
excludes individuals with chronic disabilities or terminal illness who are
dealing effectively with life’s challenges, in spite of their conditions.” (Masters,
2012)
Roy’s writing began to focus on health as a process in which illness and health
can coexist. (Roy, 2009)

7. Nursing: The Roy Adaptation Model is extremely useful in nursing. Nursing is the science and practice that
expands adaptive abilities and enhances person and environment transformation. (Roy, 2009) The goal of
promoting adaptation contributes to the patients’ health, quality of life, and dying with dignity. In order to achieve
these goals, the nurse must determine an individual’s ability to adapt. The nurse can make this determination by
thoroughly assessing behaviors as well as identifying factors that could potentially inhibit the patient’s adaptation
ability.
To incorporate Roy’s adaptive model into practice, the following 6 steps should be used:
1. Assess the behaviors from the four adaptive modes using observational skills, intuition, accurate measurements,
and interviewing skills:
o Physiological – physical
o Self-concept – group
o Role function
o Interdependence
2. Assess and categorize the stimuli for those behaviors into the following categories:
o Focal: Stimuli that is internal or external and immediately confronts the person
o Contextual: All stimuli present in the situation that all contribute to the effect of the focal stimulus
o Residual: Stimuli whose effects in the current situation are unclear (Boston College, 2012)
3. Make a nursing diagnosis based on the persons adaptive state:
o The wording of the diagnosis is a key facilitator in the development of goals
4. Set goals to promote adaptation:
o Goals should identify the behavior to be observed in addition to the way the behavior is expected to change
5. Implement interventions aimed at managing stimuli to promote adaptation:
o Interventions can include changing of stimuli and/or strengthening the adaptive processes
o During this phase, the nurse should work in collaboration with the patient to determine what outcomes are
considered desirable vs. undesirable
6. Evaluate achievement of adaptive goals:
o The nurse employs the skills of observation, intuition, measurement, and interviewing to evaluate and

8. Nurses can use The Roy Adaptation Model (RAM) in the treatment of their patients to gather
data, discover the needs of the patient's adaptive system, develop nursing care, and evaluate
the effectiveness of the care provided. An application of this model in practice can be seen in
the following example. A nurse is caring for a young patient named Julie with Type I
diabetes. With help from her mom, Julie did a good job managing her diabetes from early
age. Now in her teenage years, she is not managing her diabetes as well. RAM can be used by a
nurse in the care of Julie by:
o Adaptation: How is Julie coping with being a teenager in high school having to take insulin
injections?
o Person: How does Julie see herself in comparison to her friends that do not have diabetes?
o Environment: How is being a teenager and the friendships developed in high school influence
Julie's management of her diabetes?
o Health: How is Julie's management of her diabetes affecting her overall health?
o Nursing: As a nurse, what nursing care plan can I develop to help Julie now that she is a
teenager facing new challenges with being a diabetic? What is the nursing diagnosis and what
interventions can be implemented? What goals can we set, and how will we measure the
effectiveness of the nursing care?

9. Adaptive Modes:
o Physiological – physical > Compromised level of adaptation, shown in blood glucose level
o Self-concept – > Compensates for feeling different – does not tell friends she
group identity has diabetes
o Role function > Her roles are beginning to change – will change more
throughout high school
o Interdependence > Good relationship with parents, but wants to handle things
herself
A nurse can use RAM as a tool to speak with Julie to see how she is dealing with rapid periods of
growth, influences from peers, more activities away from home, and new stresses at school. All
of these issues (stimuli) can be affecting how Julie is now managing her diabetes. The nurse and
Julie can work together on a plan that will help Julie adapt as a person who is now a teenager
experiencing a new environment with changing influences, as well as new challenges to her
health. The nurse can develop a nursing plan with specific goals that will help contribute in a
positive way to Julie's health and overall well being. This plan should help Julie attain her goal of
becoming an expert on managing her diabetes throughout her teen-age years.

11. Alumni UCLA (2012). UCLA awards. Retrieved from
http://alumni.ucla.edu/share/ucla-awards/bio/callista-roy.aspx
Boston College (2013). Featured faculty theorist. Retrieved from
http://www.bc.edu/schools/son/faculty/featured/theorist.html
Boston College (2013). The Roy adaptation model. Retrieved from
http://www.bc.edu/content/bc/schools/son/faculty/featured/theorist/Roy_Adaptation_Model.html
Current Nursing (2012). Roy’s adaptation model. Retrieved from
http://currentnursing.com/nursing_theory/Roy_adaptation_model.html
Masters, K. (2012). Roy Adaption Model: Sister Callista Roy. Nursing theories: a framework for professional practice (p. 128).
Sudbury, MA: Jones & Bartlett Learning.
Roy, Sr. C. (2009). The Roy adaption model (3rd ed.). Upper Saddle River, NJ: Pearson.
Sacred Heart University (2013). Nursing grand theory and theorists. Retrieved from
http://nursingtheoryandtheoristsroyorem.weebly.com/about-sr-callista-roy.html
UC Denver (2012). Nurse theorists portraits of excellence, vol. 1 Callista Roy adaptation model. Retrieved from
http://www.fitne.net.hsl-ezproxy.ucdenver.edu/vlrc/user/content/nt_cr/index.html
Figure 1 retrieved from http://aquichan.unisabana.edu.co/index.php/aquichan/article/view/1527/1974
Photo image retrieved from http://knowledgenurse.files.wordpress.com/2011/08/callista_roy.png