SDS TRC AND RGICD COLLEGE OF

NURSING
BENGALURU-29.

Seminar: Roy’s Adaptation Model

Subject: Advance Nursing Practice.

Submitted To: Submitted By:

Mrs. Swetha A R Miss. Revathi H K

Head of the Departmaent, 1ST Year, M.Sc (N)

Child Health Nursing.

Date of Submission:
 ROY’S ADOPTATION MAODEL

INTRODUCTION
 Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy

 At age 14 she began working at a large general hospital, first as a pantry girl, then as a
maid, and finally as a nurse's aid.

 She entered the Sisters of Saint Joseph of Carondelet.

 she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College,
Los Angeles in 1963.

 a master's degree program in pediatric nursing at the University of California ,Los

Angeles in 1966.

 She also earned a master’s & PhD in Sociology in 1973 & 1977 ,respectively

 Sr. Callista had the significant opportunity of working with Dorothy E. Johnson

 Johnson's work with focusing knowledge for the discipline of nursing convinced Sr.
Callista of the importance of describing the nature of nursing as a service to society and
prompted her to begin developing her model with the goal of nursing being to promote
adaptation.
  Sister Callista Roy (1984), Introduction to Nursing: An Adaptation Model (2nd ed)

ADAPTATION

The process & outcome whereby thinking & feeling persons, as individuals or in groups,
use conscious awareness & choice to create human & environmental integration.

ROY'S THEORY DEFINES

“Adaptation as the process by which an individual or group makes conscious choices to

cope with his or her situation.” Adaptive responses increase people's ability to cope, and to
achieve goals including survival, growth, mastery of their lives and "personal and environmental
transformation." Successful adaptation integrates a bad situation into an individual's life, or at
least helps compensate for the problem.

ASSUMPTIONS OF ROY’S ADAPTATION MODEL

Scientific

 Systems of matter and energy progress to higher levels of complex self-organization

 Consciousness and meaning are constitutive of person and environment integration
 Awareness of self and environment is rooted in thinking and feeling
 Humans by their decisions are accountable for the integration of creative processes
 Thinking and feeling mediate human action
 System relationships include acceptance, protection, and fostering of interdependence
 Persons and the earth have common patterns and integral relationships
 Persons and environment transformations are crated in human consciousness
 Integration of human and environment meanings results in adaptation

Philosophical

 Persons have mutual relationships with the world and God

  Human meaning is rooted in an omega point convergence of the universe
 God is intimately revealed in the diversity of creation and is the common destiny of
creation
 Persons use human creative abilities of awareness, enlightenment, and faith
 Persons are accountable for the processes of deriving, sustaining, and transforming the
universe

THIS MODEL COMPRISES THE FOUR DOMAIN CONCEPTS

 Human as adaptive system

 Health
 Environment
 Nursing & six step nursing process

HUMAN AS ADAPTIVE SYSTEM

 An adaptive system with coping processes

 Described as a whole comprised of parts
 Functions as a unity for some purpose
 Includes people as individuals or in groups (families, organizations, communities,
nations, and society as a whole).
 An adaptive system with cognator and regulator subsystems acting to maintain
adaptation in the four adaptive modes: physiologic-physical, self-concept-group identity,
role function, and interdependence

ENVIRONMENT

 All conditions, circumstances, and influences surrounding and affecting the development
and behavior of persons and groups with particular consideration of mutuality of person
and earth resources
 Three kinds of stimuli: focal, contextual, and residual
  Significant stimuli in all human adaptation include stage of development, family, and
culture

HEALTH

 Health: a state and process of being and becoming integrated and whole that reflects
person and environmental mutuality
 Adaptation: the process and outcome whereby thinking and feeling persons, as
individuals and in groups, use conscious awareness and choice to create human and
environmental integration
 Adaptive Responses: responses that promotes integrity in terms of the goals of the human
system, that is, survival, growth, reproduction, mastery, and personal and environmental
transformation
 Ineffective Responses: responses that do not contribute to integrity in terms of the goals
of the human system
 Adaptation levels represent the condition of the life processes described on three
different levels: integrated, compensatory, and compromised

NURSING

 Nursing is the science and practice that expands adaptive abilities and enhances person
and environment transformation
 Nursing goals are to promote adaptation for individuals and groups in the four adaptive
modes, thus contributing to health, quality of life, and dying with dignity
 This is done by assessing behavior and factors that influence adaptive abilities and by
intervening to expand those abilities and to enhance environmental interactions
ROY ADAPTATION MODEL (RAM) –TERMS

 System-a set of parts connected to function as a whole for some purpose.

 Stimulus-something that provokes a response, point of interaction for the human system
and the environment

 Focal Stimuli-internal or external stimulus immediately affecting the system

 Contextual Stimulus-all other stimulus present in the situation.
 Residual Stimulus-environmental factor, that effects on the situation that are unclear.

 Regulator Subsystem-automatic response to stimulus (neural, chemical, and endocrine)

 Cognator Subsystem-responds through four cognitive responds through four cognitive-

emotive channels (perceptual and information processing, learning, judgment, and
emotion)

 Behavior -internal or external actions and reactions under specific circumstances

 Physiologic-Physical Mode

 Behavior pertaining to the physical aspect of the human system

 Physical and chemical processes
 Nurse must be knowledgeable about normal processes
 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection)

 Self Concept-Group Identity Mode

The composite of beliefs and feelings held about oneself at a given time. Focus on the
psychological and spiritual aspects of the human system. Need to know who one is, so that one
can exist with a state of unity, meaning, and purposefulness of 2 modes (physical self, and
personal self)
  Role function Mode

Set of expectations about how a person occupying one position behaves toward a occupying
sanother position. Basic need-social integrity, the need to know who one is in relation to others

 Interdependence Mode

Behavior pertaining to interdependent relationships of individuals and groups. Focus on the

close relationships of people and their purpose. Each relationship exists for some reason.
Involves the willingness and ability to give to others and accept from others. Balance results in
feelings of being valued and supported by others. Basic need - feeling of security in
relationships

 Adaptive Responses-promote the integrity of the human system.

 Ineffective Responses-neither promote nor contribute to the integrity of the human
system
 Copping Process-innate or acquired ways innate or of interacting with the changing of
environment
NURSING PROCESS

A problem solving approach for gathering data, identifying the capacities and needs of the
human adaptive system, selecting and implementing approaches for nursing care, and evaluation
the outcome of care provided. There are six steps;

 Assessment of Behavior (first level assessment): the first step of the nursing process
which involves gathering data about the behavior of the person as an adaptive system in
each of the adaptive modes
 Assessment of Stimuli (second level assessment): the second step of the nursing
process which involves the identification of internal and external stimuli that are
influencing the person’s adaptive behaviors. Stimuli are classified as: 1) Focal- those
most immediately confronting the person; 2) Contextual-all other stimuli present that are
affecting the situation and 3) Residual- those stimuli whose effect on the situation are
unclear.
 Nursing Diagnosis: step three of the nursing process which involves the formulation of
statements that interpret data about the adaptation status of the person, including the
behavior and most relevant stimuli
 Goal Setting: the forth step of the nursing process which involves the establishment of
clear statements of the behavioral outcomes for nursing care.
 Intervention: the fifth step of the nursing process which involves the determination of
how best to assist the person in attaining the established goals
 Evaluation: the sixth and final step of the nursing process which involves judging the
effectiveness of the nursing intervention in relation to the behavior after the nursing
intervention in comparison with the goal established.

Adaptation and Groups

 Includes relating persons, partners, families, organizations, communities, nations, and
society as a whole
Adaptive Modes
Persons

 Physiologic

 Self Concept

 Role Function

 Interdependence

Groups

 Physical

 Group Identity

 Role Function

 Interdependence

Role Function Mode

 Underlying Need of Social integrity

 The need to know who one is in relation to others so that one can act

 The need for role clarity of all participants in group

Adaptation Level
 A zone within which stimulation will lead to a positive or adaptive response

 Adaptive mode processes described on three levels:

 Integrated

 Compensatory

 Compromised

Integrated Life Processes

 Adaptation level where the structures and functions of the life processes work to meet
needs

 Examples of Integrated Adaptation

  Stable process of breathing and ventilation

 Effective processes for moral-ethical-spiritual growth

Compensatory Processes
 Adaptation level where the cognator and regulator are activated by a challenge to the life
processes

 Compensatory Adaptation Examples:

 Grieving as a growth process, higher levels of adaptation and transcendence

 Role transition, growth in a new role

Compromised Processes
 Adaptation level resulting from inadequate integrated and compensatory life processes

 Adaptation problem

 Compromised Adaptation Examples

 Hypoxia

 Unresolved Loss

 Stigma

 Abusive Relationships

ROY’S THEORY AS APPLIED TO:

1. NURSING PRACTICE

Using Roy’s six –step nursing process, the nurses assesses first the behaviors and second
the stimuli affecting those behaviors. In a third step the nurse makes a statement or nursing
diagnosis of the person’s adaptive state and fourth, sets goals to promote adaptation. Fifth,
nursing interventions are aimed at managing the stimuli to promote adaptation. The last step in
the nursing process is evaluation. By manipulating the stimuli and not the patient, the nurse
enhances the interaction of the person with their environment, thereby promoting health.
 2. EDUCATION

The adaptation model is also useful in educational setting. Roy states that the
model defines for students the distinct purpose of nursing which is to promote man’s
adaptation in each of the adaptive modes in situations of health and illness. In the early
1980’s the School of Nursing at the University of Ottawa experienced a major curriculum
change. The change included incorporating a nursing model by which to base their new
curriculum. The Roy adaptation model was one of the models to be included in the first
year of the baccalaureate program.

The professors had to meet four challenges during this change:

 Adapting the course to be congruent with the Roy model,

 Developing teaching tools suitable for student learning.
 Sequencing of content for student learning
 Obtaining competent role models.

3. 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.

STRENGTHS

 RAM offers a variety of strength for all areas of nursing.

 Focus on, & inclusion of the whole person or group.
 The 4 modes provide an opportunity for consideration of multiple aspects of the
human adaptive system & support gaining an understanding of whole system.
WEAKNESS

Weakness has been identified in relation to research &practice. One is the need for
consistent definition of the concepts & terms within the RAM as well as for more
research based on such consistent definitions.

EXAMPLE:

DEMOGRAPHIC DATA

 Name  Mr. NR
 Age  53 years
 Sex  Male
 IP number  -----
 Education  Degree
 Occupation  Bank clerk
 Marital status  Married
 Religion  Hindu
 Informants  Patient and Wife
 Date of admission  21/01/08

FIRST LEVEL ASSESSMENT

PHYSIOLOGIC-PHYSICAL MODE

Oxygenation:

Stable process of ventilation and stable process of gas exchange. RR= 18Bpm. Chest normal in
shape. Chest expansion normal on either side. Apex beat felt on left 5th inter-costal space mid-
clavicular line. Air entry equal bilaterally. No ronchi or crepitus. NVBS. S1& S2 heard. No
abnormal heart sounds. Delayed capillary refill+. JVP0. Apex beat felt- normal rhythm, depth
and rate. Dorsalis pedis pulsation of affected limp is not palpable. All other pulsations are
normal in rate, depth, tension with regular rhythm. Cardiac dull ness heard over 3rd ICS near to
sternum to left 5ht ICS mid clavicular line. S1& S2 heard. No abnormal heart sounds. BP-
Normotensive. . Peripheral pulses felt-Normal rate and rhythm, no clubbing or cyanosis.

Nutrition

He is on diabetic diet (1500kcal). Non vegetarian. Recently his Weight reduced markedly (10
kg/ 6 month). He has stable digestive process. He has complaints of anorexia and not taking
adequate food. No abdominal distension. Soft on palpation. No tenderness. No visible peristaltic
movements. Bowel sounds heard. Percussion revealed dullness over hepatic area. Oral mucosa
is normal. No difficulty to swallow food

Elimination:

No signs of infections, no pain during micturation or defecation. Normal bladder pattern. Using
urinal for micturation. . Stool is hard and he complaints of constipation.

Activity and rest:

Taking adequate rest. Sleep pattern disturbed at night due unfamiliar surrounding. Not following
any peculiar relaxation measure. Like movies and reading. No regular pattern of exercise.
Walking from home to office during morning and evening. Now, activity reduced due to
amputated wound. Mobility impaired. Walking with crutches. Pain from joints present. No
paralysis. ROM is limited in the left leg due to wound. No contractures present. No swelling
over the joints. Patient need assistance for doing the activities.

Protection:

Left lower fore foot is amputated. Black discoloration present over the area. No redness,
discharge or other signs of infection. Nomothermic. Wound healing better now. Walking with
the use of left leg is not possible. Using crutches. Pain form knee and hip joint present while
walking. Dorsalis pedis pulsation, not present over the left leg. Right leg is normal in length and
size. Several papules present over the foot. All peripheral pulses are present with normal rate,
rhythm and depth over right leg.
Senses:

No pain sensation from the wound site. Relatively, reduced touch and pain sensation in the
lower periphery; because of neuropathy. Using spectacle for reading. Gustatory, olfaction, and
auditory senses are normal.

Fluids and electrolytes:

Drinks approximately 2000ml of water. Stable intake out put ratio. Serum electrolyte values are
with in normal limit. No signs of acidosis or alkalosis. Blood glucose elevated

Neurological function:

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.

Endocrine function

He is on insulin. No signs and symptoms of endocrine disorders, except elevated blood sugar
value. No enlarged glands.

SELF CONCEPT MODE

Physical self:

He is anxious about changes in body image, but accepting treatment and coping with the
situation. He deprived of sexual activity after amputation.

Belongs to a Nuclear family. 5 members. Stays along with wife and three children. Good
relationship with the neighbours. Good interaction with the friends. Moderately active in local
social activities

Personal self:
Self esteem disturbed because of financial burden and hospitalization. He believes in god and
worshiping Hindu culture.

ROLE PERFORMANCE MODE:

He was the earning member in the family. His role shift is not compensated. His son doesn’t
have any work. His role clarity is not achieved.

INTERDEPENDENCE MODE:

He has good relationship with the neighbours. Good interaction with the friends relatives. But
he believes, no one is capable of helping him at this moment. He says ”all are under financial
constrains”. He was moderately active in local social activities

SECOND LEVEL ASSESSMENT

FOCAL STIMULUS:

Non-healing wound after amputation of great and second toe of left leg- 4 week. A wound first
found on the junction between first and second toe-4 month back. The wound was non-healing
and gradually increased in size with pus collected over the area.

He first showed in a local (---) hospital. From there, they referred to ---- medical college; where
he was admitted for 1 month and 4 days. During hospital stay great and second toe amputated.
But surgical wound turned to non- healing with pus and black colour. So the physician
suggested for below knee amputation. That made them to come to ---Hospital, ---. He underwent
a plastic surgery 3 week before.

CONTEXTUAL STIMULI:

Known case DM for past 10 years. Was on oral hypoglycemic agent for initial 2 years, but
switched to insulin and using it for 8 years now. Not wearing foot wear in house and premises.
RESIDUAL STIMULI:

He had TB attack 10 year back, and took complete course of treatment. Previously, he admitted
in ---Hospital for leg pain about 4 year back. . Mother’s brother had DM. Mother had history of
PTB. He is a graduate in humanities, no special knowledge on health matters.

CONCLUSION

Mr.NR who was suffering with diabetes mellitus for past 10 years. Diabetic foot ulcer and
recent amputation made his life more stressful. Nursing care of this patient based on Roy's
adaptation model provided had a dramatic change in his condition. Wound started healing and
he planned to discharge on 25th april. He studied how to use crutches and mobilized at least
twice in a day. Patient’s anxiety reduced to a great extends by proper explanation and
reassurance. He gained good knowledge on various aspect of diabetic foot ulcer for the future
self care activities.
NURSING CARE PLAN

ASSESS.
ASSESSME NURSING
OF INTERVENTI EVALUATI
NT OF DIAGNOS GOAL
BEHAVIO ON ON
STIMULI IS
UR

Ineffecitive Focal 1. Long-term § Maintain the Short term

protection stimuli: Impaired objective: wound area goal:
and sense in Non-healing skin 1. clean as Met: size of
physical- wound after integrity amputated contamination wound
physiologica amputation of related to area will be affects the decreased to
l mode great and fragility of completely healing process. less than 1x1
second toe of the skin healed by § Follow cms.
left leg- 4 secondary 20/5/08 sterile technique
(No pain WBC values
week to vascular while providing
sensation 2.Skin will became
insufficien cares to prevent
from the remain normal on
cy infection and
wound site.) intact with 24/4/08
delay in healing.
no ongoing
ulcerations. § Perform
Long term
wound dressing
Short- goal:
with betadine
Term Partially
which promote
Objective: Met: skin
healing and
i. Size of partially
growth of new
wound intact with no
tissue.
decreases to ulcerations.
§ Do not move
1x1 cm Continue plan
the affected area
within Reassess goal
frequently as it
24/4/08. and
 ii. No affects the interventions
signs of granulation Unmet: not
infection tissue achieved
over the formation. complete
wound § Monitor for healing of
within 1-wk signs and amputated
iii. Normal symptoms of area.
WBC infection or Continue plan
values delay in healing. Reassess goal
within 1-wk § Administer and

iv. the antibiotics interventions

Presence of and vitamin C

healthy supplementation
granular which will
tissues in promote the
the wound healing
site within process.
1-wk
Impaired Focal 2. Long term § Assess the Short term
activity in stimuli: Impaired Objective: level of goal:
physical- During physical Patient will restriction of Met: used
physiologica hospital stay mobility attain movement crutches
l mode great and related to maximum § Provide correctly on
second toe amputatio possible active and 22/4/08.
amputated. n of the physical passive he is self
But surgical left mobility exercises to all motivated in
wound turned forefoot with in 6 the extremities doing minor
to non- and months. to improve the excesses
healing with presence muscle tone and
Short term Partially
pus and black of strength.
objective: Met: walking
colour. unhealed
i. § Make the with
wound
Correct use patient to minimum
of crutches perform the support.
with in ROM exercises

22/4/08 to lower
Long term
extremities
ii. goal:
which will
walking
strengthen the Unmet: not
with
muscle. attained
minimum
maximum
support- § Massage the
possible
22/4/08 upper and lower
physical
extremities
iii. He mobility-
which help to
will be self Continue plan
improve the
motivated in Reassess goal
circulation.
activities- and
20/4/08. § Provide
interventions
articles near to
the patient and
encourage
performing
activities within
limits which
promote a
feeling of well
being.

§ Provide
positive
reinforcement
for even a small
improvement to
increase the
frequency of the
desired activity.

§ Measures for
pain relief
should be taken
before the
activities are
initiated as pain
can hinder with
the activity.
Alteration Contextual 3. Long term § Allow and Short term
in Physical stimuli: Anxiety Objective: encourage the goal:
self in Self- Known case related to The client client and Met:
concept DM for past hospital will remain family to ask demonstrated
mode 10 years and admission free from questions. Bring appropriate
on treatment and anxiety up common range
with insulin unknown concerns. effective
(He is
for 8 years. Outcome § Allow the coping with
anxious Short term
of the client and treatment
about objective:
disease family to
changes in Residual He is able to
and i.
body image) verbalize rest quietly.
stimuli: no demonstrati
financial anxiety.
special ng
constrains.
knowledge in § Stress that
Change in appropriate Long term
health frequent
Role range goal:
matters assessment are
performanc effective Unmet: client
routine and do
e mode. (He coping in not
not necessarily
was the the completely
imply a
earning treatment remained free
deteriorating
member in ii. Being from anxiety
condition.
the family. able to rest due to
His role shift § Repeat
and financial
is not information as
iii. Asking constrains-
compensate) necessary
fewer Continue plan
because of the
questions Reassess goal
reduced
and
attention span
interventions
of the client and
family
 § Provide
comfortable
quiet
environment for
the client and
family

Contextual 4. deficient Long term § Explain the Short term

stimuli: knowledge Objective: treatment goal:

Known case regarding Patient will measures to the Met:

DM for past the foot acquire patient and their Verbalization
10 years and care, adequate benefits in a and
on treatment wound knowledge simple demonstration
with insulin care, regarding understandable of foot care.
for 8 years. diabetic the t foot language.
------ Strictly
diet, and care, wound § Explain following
need of care, about the home
Residual diabetic diet
follow up diabetic care. Include the
stimuli: no plan
care. diet, and points like care
special
need of of wounds,
knowledge in Unmet:
health follow up nutrition, Demonstratio
matters care and activity etc. n of wound
practice in § Clear the care.
their day to doubts of the
day life. patient as the Long term
Short term patient may goal:
objective: present with
Unmet: not
i. some matters of
completely
Verbalizatio importance.
acquired and
n and § Repeat the practiced the
demonstrati information required
on of foot whenever knowledge.
care. necessary to Continue plan
ii. reinforce Reassess goal
Strictly learning. and
following interventions
diabetic diet
plan

iii.
Demonstrati
on of
wound care.
REFERENCE

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