1. SISTER CALLISTA ROY:
THEADAPTATIONMODEL

2. Introduction to “Sister Callista Roy"
Born in Los Angeles, California, on October 14, 1939
Second child of Mr. and Mrs. Fabien Roy
Family of seven boys and seven girls
She was named after Saint Callistus of the Roman
Catholic Calendar.
Mother was a licensed vocational nurse

3. Education
Bachelors Degree in Nursing from
Mount St. Mary’s College in 1963.
Masters in Pediatric Nursing from
University of California in 1966
Suffered with Encephalomyelitis, a neurological disorder.
Second Masters and PhD in Sociology in 1973 and 1977
She finished her postdoctoral program in Neuroscience
Nursing.

4. Professional Experience
Started at age 14.
Pediatric Nurse
Nursing instructor in many
different capacities.

5. Personal and Professional Influences
Her family, mainly her mother
Her religious beliefs
 She became a member of the Sister Of Saint Joseph of
Carondelet
Her teachers and mentors
Dr. Dorothy Johnson
 Challenged Ms. Roy to develop her Nursing theory.

6. Introduction of The Model/Theory
Adaptation was first
introduced to Ms. Roy in a
psychology class
Adaptation of children
Theory development started in 1964
First utilized in Mount St. Mary’s College

7. Roy’s Adaptation Model
Developed over the years
Supported through research
163 Research studies conducted
Has been in use for 46 years.
Published in various languages
Internationally used.

8. Primary Concepts of the Model
Key concepts are the Person (or a group) viewed as a
adaptive system, their health, and their environment.
 A person is a bio-psycho-social being.
 Both innate and acquired mechanisms are used for coping.
Assessment of behavior and the factors affecting
adaptation, and intervention to promote adaptive
abilities and enhance environmental interactions.

9. Metaparadigm: Person

10. Metaparadigm: Health
Health is the state and a process of being and
becoming an integrated and whole person.
It is a process where he or she is striving to achieve
their maximum potential.

11. Metaparadigm: Environment
All conditions, circumstances, and influences that
surrounds and effect the development and behaviour of
the person's or group" Thus all stimuli, whether internal
or external are part of the person's environment. Stimuli
from within the person and stimuli from around the
person represent the element of environment.

12. Key Definitions
System: A set of parts connected to function as a whole
for some purpose.
Coping Processes: Either Innate or acquired ways of
interaction.
Regulator Coping: Coping process involving the neural,
chemical and endocrine systems.
Cognator Coping: Coping process involving the four
cognitive-emotive channels.

13. Metaparadigm of Nursing
Nursing acts to enhance the interaction of the person
with the environment to promote adaptation
It is the science and practice that expands adaptive
abilities.

14. Key Definitions
Focal Stimulus: The internal or external stimulus
most immediately confronting the human system.
Contextual Stimulus: All other stimuli present in the
situation that contribute to the behavior of the focal
stimuli.
Residual Stimuli: factors that may be affecting
behavior but whose effects are not validated.

15. Key Definitions
Integrity: Degree of wholeness achieved by adapting
to changes in needs.
Adaptation Level: A changing point, influenced by
the demands of the situation and the person’s
internal resources.
Behavior: Actions and reactions under specified
circumstances.

16. Sister Callista Roy’s Adaptation
Model
and Application

17. Person
-Person: adaptive system constantly interacting
with external and internal environment
-Persons major task: Maintain personal integrity
(wholeness) in face of environmental stimuli.

18. Environment

19. Adaptation
Integrated, Compensatory, or Compromised
Stimuli influence adaptation level

20. Roy’s Model Continued…
Coping mechanisms: Regulator and Cognator
Control Processes: Stabilizer and Innovator
ADAPTATION

21. Four Adaptive Modes
1. Physiological- oxygenation, nutrition, elimination, activity, rest, and protection
2. Self Concept- Psychological and spiritual elements
3. Role Function- primary,secondary, and tertiary roles the person performs in society
4. Interdependence- coping mechanisms arising from close relationships
Goal: Promote integrated adaptation in all four modes = HEALTH

22. 2
Four Adaptation Modes

23. Apply the Nursing Process to Each of the Four
Adaptive Modes
1. Assess Behavior
2. Assess Stimuli
3. Nursing Diagnosis
4. Goal Setting
5. Interventions
6. Evaluation
ULTIMATE GOAL: Promote integrated adaptation in each of the
Four Adaptive Modes

24. Visual Aid
Roy’s Adaptation Model
Person-open
system
Environmental Stimuli: Focal, Contextual, Residual
Adaptation level: integrated,
compensatory, or compromised.
Health
Nursing

25. 2

26. 2
Examples of Roy’s Model in Practice
Cancer patients -Cook(1999), Gerrish (1989)
Amputations - Dawson (1998)
Occupational Health -Doyle & Rejacich (1991)
Pt’s with Anxiety- Fredrickson (1993)
Hospitalized Children- Galligan (1979), Starn & Niederhauser (1990)
Coronary Care Unit- Hamner (1989)
Adolescents with Asthma- Hennessy-Harstad (1999)
Adult Hemodialysis patients- Keen et al. (1998)
Home care- Lankester & Sheldon (1999), Schmitz (1980)
Abused Women- Limandri (1986)
Patients with Kawasaki disease- Nash (1987)
Adolescents with bulimia nervosa- Pilote (1998a,1998b)
Elderly in apartment complexes- Smith (1998)
Patients with alzheimer’s disease- Thornbury & King (1992)

27. More recently...Suggested use in Community
Health Nursing
Physical-morbidity/mortality stats,
medical facilities, funding
Group identity-culture,morale
Role function-effectiveness and
accountability of institutions (fire,
police, hospitals)
Interdependence-relationships of
community with outside
organizations, quality of
relationships within the
community
13

28. Use of Roy’s model to promote behavior change
-Have a more accurate understanding
of smoking addiction
-Explain how stress affected their physical,
mental, spiritual self and their relationships with
others
In conclusion: More accurate understanding of
addiction and perceptions of stimuli that produced
the desire to continue smoking.

29. Examples of Roy’s Adaptation Model in Research
Cross-cultural pain- Cavillo & Flaskerud (1993)
Caesarean birth- Fawcett (1990)
Child-bearing women- Fawcett & Tulman (1990), Tulman et al. (1998)
Cancer patients- Frederickson et al. (1991), Samarel et al. (1998)
Spinal cord injury patients- Harding-Okimoto (1997)
Abused women- Limandri (1986)
Well adolescents- Modrcin et al. (1998)
Breast-feeding women- Nyqvist & Sjoden (1993)
Spouses of surgical patients- Silva (1987)
Elderly persons- Smith (1988), Zhan (2000)
Persons with Alzheimer’s disease- Thornbury and King (1992)
 * List obtained from Fitzpatrick and Wall (2005)
16

30. More recently...
Brooke Army Medical Center and U.S. Army Institute of Surgical Research-
Series of studies based on Roy’s Adaptation Model
1. Quality of life experienced by people with cancer. Findings: Military patients
did not share with their healthcare provider about pain, sexual dysfunciton,
ect. because they viewed these as expected.
2 Investigate feasibility of exercise program and examine the effects on physiological and
psychological parameters of health in Cancer patients. Findings: Improved exercise tolerance,
activity, sleep patterns, and quality of life.
Excellent guide for Quality of Life outcomes in patients with long term illness
• * Yoder, L. H. (2005). Using the Roy
adaptation model: A program of research
in a military research service. Nursing
Science Quarterly 18(4), 321-323.

31. Adaptation in Children with Cancer
Used Roy’s model to guide in data collection in
adaptation modes.
Different age groups will adapt differently
Age and physical maturity have significant impact
on adaptation to cancer in pediatrics.

32. Examples of Roy’s model in Education
One of the most widely used models in the U. S. for
nursing education
Geriatric Nurse-Practitioner Program
University of Ottawa School of Nursing, Canada
Mount Saint Mary’s College, Los Angeles
 Students deliver care based on Roy’s model


33. Roy’s Model Applied to Administration
A research study explains how one hospital implemented Roy’s model to develop :
• A Nursing Philosophy
• Mission Statements
• Standards of Practice
• Job Descriptions
• Performance Planning and an Appraisal System
• A Quality Monitoring System
CONCLUSION: highly integrated system of nursing administration and
practice
*Rogers et al.,1991

34. Evaluation of Model
Adequacy
 Model developed from
belief based mainly on
pediatric clinical
observations
 Use of Harry Helson’s
adaptation theory
(Patton, 2004)

35. Evaluation of Model
Clarity
Adaptation
-How is it defined?
-Who defines it?
-How is it evaluated?
Health
-Non-specific definition

36. Evaluation of Model
Clarity
Adaptive modes have unclear
boundaries
-Interrelated by perception
Some use of theoretical jargon
 Good assessment
method
(Lewis, 1988; Patton, 2004)

37. Evaluation of Model
Complexity
 Abstract and difficult to
understand
 Concept of Person as an
adaptive system
 Cognator and regulator
subsystems
 Not easily operational for
research
-stimuli create an extensive
list of potential variables
Tolson & McIntosh, 1996
Adaptation
Coping Control
Stabilizer
Regulator Cognator
Innovator
Cognitive
Emotional
Output processes
Central processes
Input

38. Evaluation of Model
Completeness
 Addresses all four concepts of a nursing model (metaparadigm)
 Comprehensive and systematic assessment
- Observed behavior is reflective of the parts
 Focus on the individual
-> More of a downstreamapproach
Smaller perspective
 Person = adaptive system
-> Little room for humanistic
understanding

39. Clinical Use of the Model for in primary care
setting
Develops systematic and
comprehensive ways of
knowing reality
Promotes critical thinking
Focused on the Person
-rights, liberty, and
independent actions

40. Clinical Use of the Model for in primary care
setting
Helps visualize the nursing
process as a dynamic
continuum -> the patient’s
progress becomes the driving
force within the process
Provides guidance for
intervention that can enhance
quality of life and enhance
interaction of the person with
the environment
Adaptation to chronicillness
Familyfunctioning

41. Clinical Use of the Model for FNPs in
primary care setting
Limited by the perception of
adaptation
 -> need to identify client’s
perception of the problem
 The meanings attached to the
experience
 Then assist the client in
forming realistic goals in
coping with the problem

42. Clinical Use of the Model with a Geriatric
Population
Assess circumstances that might contribute to a
premature admission to a long term care facility.
Rolereversal
Powerlessness
Difficulty copingwith
disability
Adaptation ofsignificant
other
Farkas , 1981

43. Clinical Use of the Model for Cardiac Health
 Chest pain, decreased levels
of activity, fluid overload,
sleep disturbance (physiologic
mode)
 Fear, anxiety, body image
disturbance due to bypass
surgery (self-concept mode)
 Increased dependency on
others (role function)
 Relationship needs unmet
(interdependence mode)
 Self-esteem issues
(interdependence mode)

44. Conclusion
Research supports Roy’s model as evidence based
nursing process
Widely used in different settings and has enduring
characteristics (based on system’s theory)(Alligood, 2010)
Updated as knowledge increases and trends change
(Alligood, 2010)
In a world of globalization, the model is limited by
an egocentric paradigm (Cody, 2006)
Limited by the view that the individual good is the
highest good to be achieved (Cody, 2006)

45. References
https://www.slideshare.net/carolmarrs/carolcarolineand-
preethi