Sister Callista Roy developed the Adaptation Model of Nursing in the 1960s based on her observations of how individuals adapt to changes in their environment. The model views people as adaptive systems that interact with stimuli from the environment. There are four modes of adaptation: physiological, self-concept, role function, and interdependence. The goal of nursing according to the model is to promote positive adaptation by increasing adaptive responses and decreasing ineffective responses. The model has been widely applied in nursing research, education, and practice to understand how patients cope with illness or adversity.

1. Sister Callista Roy:Adaptation Model Jill N Meyokovich, RN BSN

2. Sister Callista RoyBorn 1939-presentMember of the Sisters of Saint Joseph of CarondeletBSN, MSN, Masters and Doctorate of SociologyProfessor, clinical nurse scholar, nurse theorist, author

3. Becoming of the ModelWhile working on masters, was mentored by Dorothy JohnsonChallenged to develop a conceptual modelRoy noticed the resiliency of children and changeIntrigued by adaptation becoming the eventual framework

4. Becoming of the Model cont1968: Operationalization1970: Literature debut1977: Model presentation

5. Basis of Adaptation ModelHarry HelsonRapoportdefinitionCombination became definition of a person as an adaptive systemDohrenwend, Lazarus, Mechanic, and SelyeBiological, and behavioral sciencesUnderpinnings Johnson’s behavioral model

6. Statement of theory“The goal of nursing is to promote adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health quality of life, and dignity with dying” (Roy 1999, p. 19)

7. Main premise of theory“When push comes to a shove, we will seldom disappoint ourselves. We all harbour greater stores of strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which we are made.Do not underestimate the power of a person to cope. He may be dependent now but deep within him lies the energy to adapt”http://nursingtheories.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html

8. My view of the RAMI believe the adaptation model as a framework used to see a person who is constantlyinfluenced by their environment; people have the chance to positively respond to their environment and adapt, or fail at adapting. It is the nurse who guides us in the succession of adaptation.

9. MetaparadigmPersonEnvironmentHealthNursing

10. TermsEnvironmentStimuliHealthAdaptationIneffective responsesAdaptation levelNursing

11. Key pointsKey focus is adaptationPerson is an adaptive system affected by stimuliStimuli can be internal or externalPositive outcome to stimuli allows adaptationNegative outcome/ineffective responses to stimuli alert the need for nursing intervention

12. AssumptionsMajor assumptionsScientificPhilosophicalImplicitHumanismVeritivity

13. PropositionsNursing promotes adaptive responsesNursing decreases ineffective responsesNursing enhances interaction which promotes adaptation

14. Main conceptsTwo internal mechanisms for adaptationRegulatorCognatorFour adaptive modesphysiological-physical needsself concept group identityrole functioninterdependence

15. 4 modesPhysiologicalSelf-concept/group identityRole functionInterdependence

16. Diagram RAM

17. Nursing ImplicationsGoal is directed to establishing adaptation Contribute to health, quality of life and dying with dignityRoy Adaptation Model Nursing ProcessAssessment of behaviorAssessment of stimuliNursing diagnosisGoal settingNursing interventionEvaluation

18. Internal criticism AdequacyClarityConsistencyLogical DevelopmentLevel of Theory Development

19. External CriticismComplexityDiscriminationReality ConvergencePragmaticScopeSignificanceUtility

20. Tools/InstrumentsUsed to measure perceptions of powerlessness in decision makingHealth care outcomes for cancer patientsFramework for adult survivors of multiple traumasDescribe relationship between nursing intervention and interpretation of resultsUsed as a basis for checklist for problematic behavior prediction

21. Application of theory to practiceMiddle range theory areasCaregiver well beingCoping with pain Coping with chronicity

22. Practice reflection/problemThis is not the first situation that came to mind as I was reflecting this question, but this is the most appropriate situation, I believe for this exercise. There was a woman in her 40s who presented to the ED with a c/c of assault. She was pregnant, had been vomiting, and was assumed to have taken some type of psychoactive medication due to her erratic behavior. She was uncooperative with her nurse and was yelling, crying, refusing to take her medication, and refusing a urine specimen. After about one hour of trying to coerce compliance with the woman, my colleague desperately came to me and asked if I could “try to talk some sense into this lady”. “Therapeutic communication is not my strong point Marian, you know that”, was my response. However, we have a very tight nit bond of nurses in our department, and I felt my obligation to help. I proceeded into the room with a plan to place myself in an inferior position as to elicit a feeling of safety and comfort. I said nothing as I entered the room and immediately turned the lights taking a blanket from the shelf for her. I sat down in the chair next to her and said absolutely nothing for what felt like an eternity. Finally, I asked her how I could help her. She did not respond and I sat there for yet another eternity. When I stood up to walk out she told me to sit back down. Finally she began to talk, and might I add, for a VERY long time agreeing to comply with the treatment plan.  I was thoroughly convinced that I was not going to be able to help this woman, but I was determined to try. I believe that all patients, even the most difficult ones, want help. Some people have great difficulty relinquishing control and giving trust to others. Therefore, I believe that by turning the lights off, I created a safety ground for her because she did not have to look at me. With the blanket, I showed compassion and offered her comfort. With my silence, I offered a willingness to help without saying so. By sitting in the chair, I made myself an equal instead of a superior. This was one of “proud” moments in my nursing career. I touched someone that was untouchable by others. And my fellow nurses were so shocked when I came back to the nursing station with a urine specimen they thought I voided in the cup myself! Although this was a difficult situation for the both the patient and I, I would have wanted the nurse to treat my mother or my sister just as I had treated her. I slept quite well that night.

23. Practice reflection/problemMoreno, M., Duran, M., & Hernandez, A. (2009). Nursing care for adaptation. Nursing science quarterly. Jan, 67-73.

24. Research articlesWright, P., Holcombe, J., Foote, A., & Piazza, D (1993). The Roy adaptation model used as a guide for the nursing care of an 8 year old child with leukemia. Journal of Pediatric Oncology 10(2), 68-74.Sercekus, P. & Mete, S. (2009). Effects of antenatal education on maternal prenatal and postpartum adaptation. Journal of Advanced Nursing Dec, 999-1010.

25. ConclusionRAM is a complex theoryRAM lends many applications to education and researchRAM theorizes that people are adaptive systems constantly influenced by stimuliNursing is used to increase adaptive behaviorsNursing is used to decrease maladaptive behaviors

26. ReferencesAlligood, M, & Tomey, A. (2010). Nursing theorists and their work: 7th ed. Maryland Heights MO: Mosby.Meleis, A. (2007). Theoretical nursing:4th ed.. Philadelphia: Lippincott William & Wilkins.Moreno, M, Duran, M, & Hernandez, A. (2009). Nursing care for adaptation. Nursing Science Quarterly, 22(1), 67-73.Peterson, S, & Bredow, T. (2009). Middle range theories application to nursing research: 2nd ed. Philadelphia: Lippincott William & Wilkins.Roy, C, & Andrews, H. (1999). Roy adaptation model. Stanford CT: Appleton & Lange.Roy, S.C. (1988). An Explication of the philosophical assumptions of the roy adaptation model. Nursing Science Quarterly, 1(26), 26-34.Sercekus, P, & Mete, S. (2009). Effects of antenatal education on maternal prenatal and postnatal adaptation. Journal of Advanced Nursing, Dec, 999-1010.Sister callistaroy. (2008, July). Retrieved June 1, 2010 from http://nursingtheories.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html Wright, P, Holcombe, J, Foote, A, & Piazza, D. (1993). The Roy adaptation model used as a guide for the nursing care of an 8 year old child with leukemia. Journal of Pediatric Oncology Nursing, 10(2), 68-74.