THIS PPT CONTAIN INFORMATION ABOUT ROYS ADAPTATION THEORY WITH SUITABLE EXAMPLE

1. CALLISTA ROY
THEORY
prepared by : Mrs.
Pinky Antony
Presented by
Mrs. Arockia Mary
Associate Prof

2. INTRODUCTION
 Sister Callista Roy began her nursing career in
1963 after receiving her Bs in Nursing from Mount
Saint Mary’s college, Los Angels.
 In 1966, she received her Ms in Nursing, and in
1977, her Doctorate in sociology from the University
of California, Los Angels.
 In 1964, Roy began work on her model when
professor Dorathy .E. Johnson, a behavior model
theorist, challenged her during a graduate seminar
class to develop a conceptual model for nursing.

3. cont
 In 1968, Mount Saint Mary’s college, Los
Angels adopted Roy’s Model as
framework for its UG nursing curriculum.
 In 1976, Roy published Introduction to
nursing: an Adaptation Model. In 1984, after
further clarification and refinement of the
model through research and testings, she
published a revised version.

4. SYSTEM
GENERAL INFORMATION:
 ARE A SET OF ORGANIZED COMPONENTS
RELATED TO FORM A WHOLE;
 REACT TO AND INTERACT WITH OTHER
ENVIRONMENT
 HAVE BOUNDERIES THAT ARE FLEXIBLE AND
OPEN TO PERMIT INTERACTION WITH OTHER
SYSTEMS.
 EMPLOY A FEEDBACK CYCLE OF INPUT,
THROUGHPUT, AND OUTPUT

5. INPUT
 Input is identified as STIMULI, which can come
from the environment or from within a person.
 Stimuli are classified as FOCAL (immediately
confronting the person CONTEXTUAL (all other
stimuli that are present), or RESIDUAL (non
specific such as cultural beliefs or attributes about
illness)
 Each person’s adaptation level is unique and
constantly changing

6. THROUGHPUT
 Throughput makes use of a person’s
processes and effectors
 Processors refer to the control
mechanisms that a person uses as an
adaptive system.
 Effectors refer to the physiologic function,
self-concept , and role function involved
in adaptation.

7. OUTPUT
 Output is the outcome of the system; when the
system is a person, output refers to the
person’s behaviors.
 In Roy’s system, output is categorized as
adaptive response (those that promote a
person’s integrity) or ineffective responses
(those that do not promote goal achievement;
for example, not taking antihypertensive
medication)

8. Cont.,
 Adaptive responses are used when person
demonstrates behaviors that achieve the
goals of survival, growth, reproduction, and
mystery
 These responses, or output, provide
feedback for the system.

9. COPING MECHANISM
 Are the processes or behavior patterns that a
person uses for self-control
 Can be inherited or learned
 Are of two types: the regulator and the
cognator; these two mechanisms are
subsystems of the person’s adaptive system
 Must act together to maintain the integrity of
the person as an adaptive system

10. REGULATOR
 The regulator subsystem consists of input,
internal processes, and output.
 input stimuli can come from the external
environment or from within the person
 internal processes – including chemical,
neural, and endocrine – transmit the stimuli,
causing output, a physiologic response
 the regulator subsystem controls internal
processes related to physiologic needs (such as
changes in heart rate during exercise)

11. COGNATOR
 the Cognator subsystem consists of input,
internal processes, and output
 it regulates self-concept, role function, and
interdependence
 the cognator subsystem controls internal
processes related to higher brain functions,
such as perception, information
processing, learning from past
experience, judgment, and emotion
 For example, a client with diabetes who decides
to increase insulin intake based on symptoms of
high blood glucose.

12.  Adaptive modes
 are part of the internal processes and act as
system effectors
 Are categories of behavior to adapt to stimuli
 Include physiologic function, self-
concept, role function, and
interdependence; the regulator and the
cognator act within these modes

13. Cont..
 Can be used to determine a person’s
adaptation level; this level, which is
exhibited by a person’s behavior, reflects the
use of adaptive modes and coping
mechanisms.
 Can be used to identify adaptive or
ineffective responses by observing a person’s
behavior in relation to the adaptive modes

14. PERSON AS AN ADAPTIVE SYSTEM

15. 1.Physiologic- Physical Mode
.Physiologic function
Involves the body’s basic
needs and ways of adapt
.Includes a person’s patterns of
oxygenation, nutrition,
elimination, activity, and rest;
skin integrity; sense; fluids and
electrolytes; and neurologic and
endocrine function
.Is less abstract than the other
three adaptive modes
PHYSIOLOGIC ADAPTATION

16. 2.Self Concept -Group Identity
Mode:
. Self- concept- Refers to
beliefs and feelings about
oneself
.Comprises the
-physical self (includes
sensation and body image)
-personal self (includes self-
consistency and self-
ideal)and
-moral and ethical self
(includes self-observation
and self-evaluation)

17. ROLE FUNCTION
 Involves behavior based on a person’s
position in society
 Is dependent on how a person interacts
with others in a given situation
 Can be classified as primary (age, sex),
secondary (husband, wife), or tertiary
(temporary role of a coach)

18. 4.Interdependance Mode
.Involves a person’s
relationship with significant
others and support systems
.Strikes a balance between
dependent behaviors (seeking
help, attention, and affection)
and independent behaviors
(taking initiative and obtaining
satisfaction from work)
.Meets a person’s needs for
love, nurturing, and affection

19. METAPARADIGM
OF ROY’S
ADAPTATION
PERSON
GOAL OF
NURSING
HEALTH
ENVIRONME
NT

20. PERSON
 Is the recipient of nursing care; Roy implies
that a client has an active role in the care
 Is a BIOPSYCHOSOCIAL BEING who
constantly interacts with a changing
environment
 Is an adaptive system who uses innate and
acquired coping mechanisms to deal with
STRESSORS
 Can be an individual, family, group,
community, or society

21. ENVIRONMENT
 is defined by Roy as all conditions,
circumstances, and influences surrounding
and affecting the development and behavior
of person and groups
 Consists of internal and external
environments, which provide input in the
form of stimuli
 Is always changing and constantly
interacting with the person

22. HEALTH
 1. Was originally described by Roy as
health-illness continuum, with one end of
the continuum being death and the other
end wellness; health and illness considered
an inevitable dimension of the person’s life
 2. is currently defined by Roy as a process
of being and becoming an integrated and
whole person;
 3. health is viewed as the goal of the
person’s behavior and the person’s ability
to be an adaptive organism

23. NURSING
1. is required when a person expends more
energy on coping, leaving less energy
available for achieving the goals of
survival, growth, reproduction, and
mastery
2. uses the four adaptive modes to increase
a person’s adaptation level during health
and illness
3. employs activities that promote adaptive,
not ineffective, responses in situations of
health and illness
4. is a practice – centered discipline geared
toward persons and their responses to
stimuli and adaptation to the environment
5. includes assessment, diagnosis, goal
setting, intervention, and evaluation.

24. THE NURSING PROCESS
RAM offers guidelines to nurse in
developing the nursing process.
The elements :
 First level assessment
 Second level assessment
 Diagnosis
 Goal setting
 Intervention
 evaluation

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

26. 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
 S1& S2 heard. No abnormal heart sounds.
 Delayed capillary refill+.
 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.
 BP- Normotensive. . Peripheral pulses felt-Normal rate and
rhythm, no clubbing or cyanosis.

27. 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

28. 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.

29. 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.

30. Cont..
 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

31. 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.

32. Cont..
 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.

33. 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.
 olfaction, and auditory senses are normal.

34. 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

35. 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.

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

37. SELF CONCEPT MODE-
Physical self
 He is anxious about changes in body
image, but accepting treatment and
coping with the situation.
 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

38. PERSONAL SELF
 Self esteem disturbed because of
financial burden and hospitalization.
 He believes in god and worshiping
Hindu culture.

39. 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.

40. 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

41. 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.

42. 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.

43. 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.

44. 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.

45.  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.