 nurse theorist, writer, lecturer,

researcher and teacher

 Professor and Nurse Theorist at the
Boston College of Nursing in Chestnut
Hill
 Born at Los Angeles on October 14,
1939.
 Bachelor of Arts with a major in
nursing - Mount St. Mary's College,
Los Angeles in 1963.
 Master's degree program in pediatric
nursing - University of California, Los
Angeles in 1966.
 Master’s and PhD in Sociology in
1973 and 1977.
 Worked with Dorothy E. Johnson
 Worked as f faculty of Mount St.
Mary's College in 1966.
 Organized course content
according to a view of person
and family as adaptive systems.
 RAM as a basis of curriculum at
Mount St. Mary’s College
 1970 - The model was
implemented in Mount St.
Mary’s school
 1971- she was made chair of the
nursing department at the
college.
 Roy’s Adaptation Model for Nursing was derived
in 1964 from Harry Helson’s Adaptation
Theory – adaptive responses are a function of
the incoming stimulus and the adaptive level

 Roy combines Helson’s work with Rapport’s

definition of system and views the
person as an adaptive system.
 After the development of her theory, Roy developed
the model as a framework for nursing practice,
research, and education.

 According to Roy, more than 1500 faculty and

students have contributed to the theoretical
development of the adaptation model.

 The model uses concepts from AH Maslow to

explore beliefs and values of persons. Roy’s holistic
approach to nursing is based in humanism.
 A pilot research study and a survey research
study from 1976 to 1977 led to some tentative
confirmations of the model.

 From this beginning, the adaptation model has

been supported through research in practice and
in education.
 A set of units so related or connected as to form
a unity or whole and characterized by inputs,
outputs, and control and feedback processes.
 A constantly changing point, made up of focal,
contextual and residual stimuli, which represent
the person’s own standard of the range of stimuli
to which one can respond with ordinary adaptive
responses.
 The occurrences of situations of inadequate
response to need deficits or excesses.

 Seen not as nursing diagnosis, but areas of

concern for the nurse related to adapting person
or group (Within each adaptive mode)
 Focal Stimulus – the degree of change or stimulus most
immediately confronting the person and the one to which
the person must make an adaptive response, that is, the
factor that precipitates behavior

 Contextual Stimuli – all other stimuli present that

contribute to the behavior caused or precipitated by the focal
stimuli

 Residual Stimuli – factors that may be affecting

behavior but whose efforts are not validated
 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.
 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, that is, survival,
growth, reproduction, and mastery
1. Physiological Mode – involve the body’s basic
needs and ways of dealing with adaptation in
regard to fluid and electrolytes; exercise and rest;
elimination; nutrition; circulation and oxygen; and
regulation, which includes the senses, temperature
and endocrine regulation

2. Self-Concept Mode – the composite of beliefs

and feelings that one holds about oneself at a given
time. It is formed from perceptions, particularly of
other’s reactions, and directs one’s behavior.
(physical self and personal self)
3. Role Performance Mode – role function is the
performance of duties based on given positions
in society.

4. Interdependence Mode – involves one’s

relations with significant others and support
systems. In this mode one maintains psychic
integrity by meeting needs for nurturance and
affection.
 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.
 Health and illness are inevitable dimensions of
the person’s life.
 To respond positively to environmental changes, the
person must adapt.
 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.
 The person has 4 modes of adaptation: physiologic
needs, self- concept, role function and inter-
dependence.
Nursing
• A “theoretical system of
knowledge which prescribes a
process of analysis and action
related to the care of the ill or
potentially ill person.”

• Roy differentiates nursing as a

science from nursing as a
practice discipline.
Person
• A “biopsychosocial being in constant
interaction with a changing environment.”

• The recipient of nursing care, as a living,

complex, adaptive system with internal
processes (cognator and regulator) acting
to maintain adaptation in the four
adaptive modes (physiological needs, self-
concept, role function, and
interdependence.)

• The person as a living system is “a whole

made up of parts of subsystems that
function as a unity for some purpose.”
Health
• A “state and a process of
being and becoming an
integrated and whole person.
Lack of integration
represents lack of health.”
Environment
• “all the conditions, circumstances,
and influences surrounding and
affecting the development and
behavior of persons or groups. ”

• The input into the person as an

adaptive system involving both
internal and external factors (may be
slight or large, positive or negative)

• Any environmental change demands

increasing energy to adapt to the
situation. Factors in the environment
that affect the person are categorized
as focal, contextual, and residual
stimuli.
Outcome Theory - well articulated
conception of man as a nursing client and of
nursing as an external regulatory mechanism.
 Both deductive and inductive

 Deductive – derived from Helson’s Theory. Helson developed the

concepts of focal, contextual, and residual stimuli, which Roy defined
within nursing to form a typology of factors related to adaptation
levels of persons. Roy also uses other concepts and theory outside
the discipline of nursing and relates these to her adaptation theory.

 Inductive – she developed the four adaptive modes from research

and practice experiences of herself, her colleagues, and her students.
Roy built on the conceptual framework of adaptation and as a result
developed a step-by-step model by which nurse use the nursing
process to administer nursing care to promote adaptation in
situations of health and illness.
 Useful for it outlines the features of the discipline and
provides direction for practice

 The model considers goals, values, the client, and

practitioner interventions

 Using Roy’s six-step nursing process, the nurse:

1. Asesses behaviors
2. Asseses stimuli
3. Diagnosis
4. Sets goals to promote adaptation
5. Nursing interventions
6. Evaluation
 The model is a valuable tool to analyze overlap
and distinctions between the professions of
nursing and medicine.

 Throughout the 1970’s and 1980’s, Roy’s model

has been implemented as a basis for curriculum
development in associate degree diploma,
baccalaureate, and higher degree programs in
many countries.
 The model does generate many testable
hypothesis related to practice and theory.
Middle range theories have been derived from RAM

› Samarel, N., Fawcett, J., Krippendorf, K., Piacentino, J.C., Eliasof, B., Hughes,
P., Kowitski, C., and Ziegler, E. (1998). Women's perception of group
support and adaptation to breast cancer. Journal of Advanced Nursing.
28(6), 1259-1268.

› Yeh, C. H. (2001). Adaptation in children with cancer: research with Roy's

model. Nursing Science Quarterly. 14, 141-148.

› Zhan, L. (2000). Cognitive adaptation and self-consistency in hearing-

impaired older persons: testing Roy's adaptation model. Nursing Science
Quarterly. 13(2), 158-165.
 Clarity - logical; claims to follow a holistic view
but leaves out “spiritual, humanistic, and
existential aspects of being a person”

 Simplicity – has several major concepts and

subconcepts and numerous relational
statements; complex
 Generality – generalizable to all settings in nursing
practice, but is limited in scope because it primarily
addresses the concept of person-environment
adaptation and focuses primarily on the client

 Empirical Precision – Testable hypothesis have been

derived from the model

 Derivable Consequences – has a clearly defined

nursing process and can be useful in guiding clinical
practice; capable of generating new information
through hypothesis-testing
 www.currentnursing.com

 Tomey, A.M., (1994). Nursing Theorists and Their

Work. 3rd ed. Missouri: Mosby