Group Project

1. Sister Callista Roy:
The Roy Adaptation Model
Vyridyana Foster, Hayley Forrest, Corinne Flora,
Kayla Fitzke, & Alyece Galbreath
Old Dominion University

2. Theory
Roy’s Adaptation Model focuses on the concept of the adaptation of a person. A person is constantly stimulated
by different things in their environment and by their self. They then have a choice of whether they adapt to this
stimuli or respond ineffectively. Roy’s Adaptation Model consists of three classes of stimuli: focal, contextual,
and residual stimuli (Alligood, 2018).
There are two subsystems in Roy’s Adaptation Model. The primary subsystem is comprised of the regulator and
the cognator. The secondary subsystem consists of four adaptive modes: physiological needs, self-concept, role
function, and interdependence. The regulator uses the physiological mode to respond automatically through
neural, chemical, and endocrine coping processes. The cognator coping system uses self-concept, role function,
and interdependence by responding through emotive channels: perceptual information processing, learning,
judgement, and emotion. The regulator creates perceptions and those perceptions are processed by the cognator
(Alligood, 2018).
The nurses role is to assist the patient in their adaptation to manage the environment or self (Alligood, 2018).

3. Stimulus
A stimulus is any element that contributes to a reaction or outcome to the adaptation level (Alligood, 2018).
❖ Focal stimuli: An internal or external stimulus that immediately confronts the individual (Alligood, 2018)
❖ Contextual stimuli: All other stimuli present that contribute to the effect of the focal stimulus (Alligood, 2018)
❖ Residual stimuli: Environmental factors of which the effects are unclear in any given situation (Alligood, 2018).

4. Adaptive Modes
❖ Physiological-physical mode: Associated with the physical and chemical processes required
by all living beings (Alligood, 2018)
Basic : Oxygenation, nutrition, elimination, activity, rest, and protection
Complex : Fluid,melectrolyte, acid-base balance, neurological and endocrine function
❖ Self-concept-group identity mode: Focuses on the psychological and spiritual feature of the
human system (Alligood, 2018)
-Physical self, personal self, and moral-ethical-spiritual self
❖ Role function mode: Focuses on the role of an individual in the community (Alligood, 2018)
❖ Interdependence mode: Focuses on significant relationships and behaviors individuals have
with others (Alligood, 2018)
-Love, respect, value, nurturing, knowledge, skills, commitments, material possessions, time,
and talents
(Four Adaptive Modes, 2018)

5. Case Study
Mrs. M. is a 37-year-old single mother with two school-age children. Mrs. M. suffered multiple facial injuries as a result of a
motor vehicle accident several months ago. The injuries have healed without complications, but she has moderate residual scarring.
Assessment of Mrs. M. begins with the behaviors manifested from the four adaptive modes. The nurse uses observational
skills, intuition, measurements, and interviewing skills to collect data. The nurse involves Mrs. M. in the assessment to verify the
nurse’s own perceptions. The nurse verifies that Mrs. M. has generally adapted well following the motor vehicle accident. The
exception is the self-concept mode: Some of her behaviors are ineffective in relation to adaptation, as evidenced by Mrs. M.’s
avoidance of social gatherings, wearing dark glasses and big hats, and wearing heavy makeup to cover her scars.
Next, the nurse and Mrs. M. set goals to promote adaptation. Goal setting for Mrs. M. within the framework involves
statements of measurable behavioral outcomes of nursing care that will promote adaptation related to body image within the self-
concept adaptive mode. The nurse, in collaboration with Mrs. M., chooses interventions based on current best practices to promote
adaptation by either changing stimuli or strengthening Mrs. M.’s adaptive processes. Evaluation focuses on judging the effectiveness
of nursing interventions in relation to Mrs. M.’s behaviors. In addition, if any other nursing problems are uncovered during the
assessment, the nurse addresses those problems simultaneously using the process described and incorporating best practices to provide
appropriate nursing care.

6. Care Plan for Mrs. M

7. 1. Disturbed Body Image: Self-Concept-Group Identity Mode
Rationale: Mrs. M has been avoiding social gatherings, wearing dark glasses, big hats, and wearing heavy makeup to cover
her scars. The injuries have healed without complications, but she has moderate residual scarring and is obviously very
self-conscious about the scars due to the actions she is taking to make sure they are hidden from others. A disturbed body
image r/t a traumatic event breaks down self confidence and allows depression and self isolation to occur.
Interventions: Assess Mrs. M’s perceived impact of change in ADL’s, social participation, personal relationships, and
occupational activities
Support verbalization of negative or positive feelings about the actual or perceived loss
Acknowledge and accept Mrs. M’s expression of feelings
Set limits on maladaptive behavior
Maintain nonjudgmental attitude while giving care
Help patient identify positive behaviors that will aid in recovery

8. Disturbed Body Image: Self-Concept-Group Identity Mode
Implementing Roy’s theory into nursing practice is a six-step process.
1. Assess the behaviors manifested from the adaptive mode:
The nurse has verified that Mrs. M has generally adapted well following the motor vehicle accident. The exception is the
self-concept identity mode. Some of her behaviors are ineffective in relation to adaptation, as evidenced by Mrs. M’s
avoidance of social gathering, wearing dark glasses and big hats, and wearing heavy makeup to cover her scars.
2. Assess the stimuli for those behaviors and categorize them as focal, contextual, or residual
Focal stimuli - Multiple facial injuries
Contextual stimuli - Motor vehicle accident
Residual stimuli - Mrs. M is a 37 y/o single mother with two school-age children

9. Disturbed Body Image: Self-Concept-Group Identity Mode
3. Make a nursing diagnosis of the person’s adaptive state.
The nursing diagnosis for Mrs. M is Disturbed Body Image related to facial scarring.
4. Set goals to promote adaptation.
Goals for Mrs. M include Mrs. M incorporating the changes into her self-concept without negating self-esteem and being able to verbalize
acceptance of self.
5. Implement Interventions
Observe past coping mechanisms and reinforce these; acknowledge that anger, denial and depression are normal feelings following this change;
allow for a gradual transition of showing more of her scars at home and in public; and, encourage patient to explore self-ideal, self-criticism and be
accepting of self.
6. Evaluate if goals have been met.
Evaluate if interventions were effective in meeting established goals and if effective adaptation occured in the Self-Concept Identity Mode.

10. 2. Acute Pain: Physiological-Physical Mode
Rationale: Mrs. M was in a motor vehicle accident several months ago that resulted in multiple facial injuries.
She is already reminded about the accident by the visible scars on her face. Daily pain related to the accident
would only make it more difficult to transition past the accident and move on into acceptance of her new
situation. Pain could also promote self isolation and prevent her from going to social gatherings due to her being
uncomfortable.
Interventions: Assess Mrs. M’s pain regularly
Determine the appropriate pain relief method (pharmacological or non pharmacological methods)
Foresee the need for pain relief before it becomes unbearable
Provide rest periods to promote relief, sleep, and relaxation

11. 3. Caregiver Role Strain: Role Function Mode
Rationale: Mrs. M is a single mother of two schooled-age children; making this her main secondary role which
typically requires her to attend public functions such as school field trips, sporting events and play dates. Mrs. M’s
reluctance to attend these public events r/t her scars puts a significant amount of stress on her as a mother and
inevitably makes her feel guilty for not completing her role as mother in the same way she did before the accident.
Interventions: Evaluate Mrs. M’s physical and mental health status that can affect caregiving
Assess for family resources and support systems
Recommend the use of community resources
Encourage the involvement of other family members to relieve stress on Mrs. M
Introduce stress-reducing methods to Mrs. M

12. References
Alligood, M. R. (2018). Nursing theorist and their work (9th ed.). St. Louis, MO: Mosby, Inc.
Four Adaptive Modes. (2018). Retrieved from http://ple.odu.edu/courses/201910/nurs306/modules/3/1/4
Nurselabs.com. (n.d.) Roy Adaptation Model Diagram of Human Adaptive Systems. Retrieved from
https://nurseslabs.com/sister-callista-roys-adaptation-model/
Roy’s Adaptation Model. (n.d.) Sister Callista Roy. [photograph]. Retrieved from
https://sites.google.com/site/culpepperram/