Origin of theory/ model
Define the theory
Five big elements of Roy’s adaptation
Application of theory and nursing process
Application of model with Example
Application of theory/ model in other areas
Evaluation of theory/ model
4. Sr. Callista Roy, a prominent nurse theorist,
writer, lecturer, researcher and teacher.
Professor and nurse theorist at the Boston
college of nursing in Chestnut Hill.
Born in Los Angeles, California, on October 14,
Second child of Mr. and Mrs. Fabien Roy
Mother was a licensed vocational nurse
Roy was designated as a 2007 Living Legend
by the American Academy of Nursing.
A member of Sigma, Theta, Tau.
5. Bachelors of Arts with a major Degree in
Nursing from Mount St. Mary’s College,
Los Angeles in 1963.
Master’s degree program in Pediatric
Nursing at the University of California in
She also earned a Second Masters and PhD
in Sociology in 1973 and 1977,
6. Suffered with Encephalomyelitis, a
Dr. Roy also had the opportunity to be a
clinical nurse , scholar two-year
postdoctoral program in Neuroscience
Nursing at University of California, She
selected this field to develop her
understanding of the holistic person,
especially as an adaptive system. And
because of her familiarity with this clinical
area as a result of her own neurological
7. Started at age 14 as a nurse aid
Nursing instructor in many different
She has lectured across the united states and in
then thirty other countries.
Sr. Callista Roy had the significant opportunity of
working with Dorothy E. Johnson.
One of her teachers and mentor is : Dr. Dorothy
She was Roy’s main influence to develop her model with
the goal of nursing being to promote adaptation.
8. Roy credits Dorothy E. Johnson as having a strong
influence in stimulating her creative processes.
In 1968, fellow faculty at Mount Saints Mary’s
college voted unanimously to adapt the
adaptation framework as the philosophical basis
of the nursing curriculum.
In 1970, the model was implemented in Mount
St. Mary’s college.
Roy ,again, credits Johnson for encouraging her
to publish her work. Resulting publications
include the first and second editions of
introduction to Nursing : An Adaptation Model.
In 1971, she was announced for the chairman of
the Department of nursing at Mount Saints Mary’s
college in Los Angeles.
9. Adaptation was first introduced to Ms. Roy
in her psychology class.
Adaptation of children:
While working as a Pediatric nurse, Roy had
noticed the great resiliency of children and their
ability to adapt in response to major physical and
Theory development started in 1964 &
implemented in 1970.
10. Roy was challenged in a seminar by another
theorist Dorothy E. Johnson to develop a
theory of nursing, subsequently in 1970, ‘the
Roy Adaptation model’ was born as a
derivation of Bertalanfty (1968) general
system theory and Harry Helson’s Adaptation
level theory (1964).
14. There are five elements in Roy’s adaptation
model. These elements are the:
The goal of nursing
15. Roy states that the recipient of nursing care may be
the individual, a family, a group, a community, or a
Each is considered as an adaptive system.
An adaptive system combines the concept of
adaptation and of a system.
First, consider the concept of system as applied to an
16. Person, as living systems, are in constant
interaction with their environments.
Between the system and the environment
occurs an exchange of information, matter
This characteristic of a living system is called
Dunn, a system theorist, calls our attention
to the smallest unit of life, the cell. The cell
is a living open system.
The cell has its inner and outer worlds.
17. The constant interaction of persons with
their environment is characterized by both
internal and external change.
Within this changing world persons must
maintain their own integrity: I.e.. each
person must adapt.
Hence, the person is viewed as an adaptive
18. The person as an adaptive system.(From Callista Roy,
introduction to nursing : an adaptation model.
19. 1.Input: The adaptive system has input coming
from the external environment as well as
input coming internally from itself.
Example of external environment :
temperature, an electrical current or a
Example of internal environment :
partial pressure of oxygen in the body, the
presence of pain, or the movements of an
Roy identifies inputs as stimuli & adaptation
20. Three types of stimuli influence an individual’s ability to
cope with the environment:
*Focal stimuli are those that immediately confront the
individual in a particular situation.
*Contextual stimuli are all other stimuli of the person’s
internal and external world that influence the situation
and are observable, measurable or subjectively
reported by the person.
*Residual stimuli are those make-up characteristics of the
person that are present and relevant to the situation but
are elusive or difficult to measure objectively.
21. *Example: Mr. Smith experiencing chest pain
Focal- includes the deficit of oxygen supply to his
Contextual- includes the 90 degree temperature,
the sensation of pain, Mr. Smith’s age, weight,
blood sugar level, and the degree of coronary
Residual- includes his history of cigarette smoking
and work-related stress.
Roy’s Model Continued…
23. Input also includes a person’s adaptation
Each person’s adaptation levels is unique and
constantly changing. It is a zone within which
stimulation will lead to a adaptive responses.
Along with stimuli the adaptation level of
human system act as an internal input to the
system as an adaptive system.
Three levels identified by Roy are:
24. 1) Integrated processes:
Adaptation level where the structures &
functions of the life processes work to meet
Stable process of breathing and ventilation
Effective processes for moral-ethical-spiritual
2) Compensatory processes:
Adaptation level where the cognator and
regulator are activated by a challenge to the life
Examples: grieving as a growth process, higher
levels of adaptation and transcendence
Role transition, growth in a new role.
25. 3) Compromised processes:
Adaptation level resulting from inadequate
integrated and compensatory life processes.
27. Control processes refers to the control
mechanisms that a person uses an adaptive
Internal dynamics act as control processes.
Roy used the term coping mechanisms to
describe the control processes of the human
as an adaptive system.
Some coping mechanisms are inherited /
genetic e.g. WBC’s defense system against
bacteria seeking to invade the body.
Other mechanism are learned e.g. use of
antiseptics to cleanse a wound.
28. These mechanisms are as following:
o The regulator and the cognator, Roy’s
model considers these mechanisms as
subsystems of the person as a system.
o These subsystems are the mechanisms
used by human beings to cope with
stimuli from the internal and external
29. Has the system components of input, internal
process, and output. Input stimuli may
originate externally or internally to the
person. The transmitters of the regulator
subsystem are chemical, neural, or endocrine
in nature. Autonomic reflexes which are
neural responses originating in the brain
stem & spinal cord, are generated as output
behaviors of the regulator subsystem. Target
organs and tissues under endocrine control
also produce regulator output behaviors.
Finally Roy presents psychomotor responses
originating from CNS as regulator subsystem.
30. An example of a regulator process is:
when a noxious external stimulus is visualized
and transmitted via the optic nerve to higher
brain centers and then to lower brain
The sympathetic neurons from these origins
have multiple visceral effects, including
increased blood pressure and increased heart
31. Output behavior of the regulator subsystem can be
feedback stimuli to the cognator subsystem.
Cognator control processes are related to the higher
brain functions of perceptual/information processing,
judgment, and emotion.
Perceptual/information processing is related to the
internal process of selective attention, coding &
Learning is correlated to the processes of imitation,
reinforcement, and insight.
Problem solving and decision making are the internal
processes related to judgment; and finally, emotion
has the processes of defense to seek relief , affective
appraisal, & attachment.
Hence , in maintaining integrity of the person, the
regulator and cognator are postulated as frequently
Example: Pp: 303.
32. The regulator & cognator mechanisms are
viewed as acting with four effectors or
adaptive modes of physiologic functions, self
concept, role function & interdependence.
involved in adaptation.
These four modes are the channels through
which the person adapts to internal and
34. 1.Physiological function- involves body’s basic
needs and ways to adapt. It includes:
oxygenation, nutrition, elimination, activity, rest,
skin integrity, fluid and electrolytes, neurological
functions and endocrine functions.
2. Self Concept- refers to beliefs and feelings about
oneself. Comprises physical self( sensation & body
image) and moral & ethical self (self observation
35. 3. Role Function- involves behavior
based on persons position in society.
- Depends on how a person interacts
with other in a given situation.
- Primary, secondary, and tertiary roles
the person performs in society.
Involves a person’s relationship with
significant others and support systems.
A balance between dependent behaviors
(seeking help, attention, affection) and
independent behaviors (taking initiative
& obtaining satisfaction from work).
Meets a person’s need for love, nurturing,
36. Output is the outcome of the system; when the
system is a person. Output refers to the persons
In Roy’s system, output is categorized as:
Adaptive responses: are those that promote the
integrity of human system. It is behaviorally
demonstrated when the system is able to meet
Ineffective responses: are those that do not
support the goals of humans as adaptive system.
they can immediately or gradually threaten the
survival of the system.
These responses or output, provides feedback
to the system.
37. Roy defines the goal of nursing as the promotion
of adaptive responses in relation to the four
adaptive modes. Adaptive responses are those
that positively affect health.
Internal & external changes, that is input
stimuli, interface with the person’s state of
coping, the other significant element in
adaptation process. The condition of the person
or the individual’s state of coping is that
person’s adaptation level.
The person’s adaptation level will determine
whether a positive response to internal or
external stimuli will be elicited.
38. The person’s adaptation level is determined by
focal, contextual and residual stimuli.
The degree of change facing the person is
equated to the focal stimulus. If the person’s
adaptation level is viewed as a line, the zone of
adaptation is the distance above and below that
line that sets the limit of the person’s adaptation
When the total stimuli (focal, contextual,
residual) fall within the person’s zone of
adaptation, an adaptive response or output
However, when the total stimuli fall outside the
individual’s zone of adaptation, ineffective
output behavior or response occur.
40. In the example of Mr. smith, the total
stimuli had fallen outside his adaptation
zone. So the deficit of oxygen to his heart
indicated by chest pain, was an ineffective
This response became the feedback to the
system as a regulator system and a focal
Mr. smith realized the cognator mechanism
to adjust the total stimuli by going indoors to
a cooler room and deceasing his oxygen
needs by sitting down and elevating his legs.
After the adjustment of the stimuli, the
oxygen needs of his heart muscles were met,
and the pain stopped.
41. Nurses act by manipulating the focal,
contextual, or residual stimuli on the person,
so that adaptive responses are promoted.
Additionally, Nurses act to expand the
person’s adaptation level so that coping
ability is expanded and the person can
tolerate a wider range of stimuli.
Plans that broaden the person’s adaptation
level correlate with the ideas of health
42. Roy defines health as, “a state or process of
being or becoming an integrated and whole
The integrity of the person is expressed as the
ability to meet the goals of survival, growth,
reproduction and mastery.
By using this model, helps to utilize the concept
of health as the goal point for the person’s
When a disproportionate amount of the person’s
energy is utilized in coping, less energy is
available to meet the goals of survival, growth ,
reproduction & mastery.
Energy freed from ineffective behavior becomes
available for promotion of health.
43. In Roy’s model, people exists in a relationship
open to the internal and external stimuli that
impinge on them. The environment is,
therefore, considered as the internal and
external stimuli relative to the person.
Roy defines the environment as, “ all
conditions, circumstances, and influences
surrounding and affecting the development
and behavior of persons or groups”.
74. 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 alzheimer’s disease- Thornbury & King (1992) .
76. Cross-cultural pain- Calvillo & Flaskerud (1993)
Caesarean birth- Fawcett (1990)
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)
Spouses of surgical patients- Silva (1987)
Elderly persons- Smith (1988), Zhan (2000)
Persons with Alzheimer’s disease- Thornbury and King (1992)
Brooke Army Medical Center and U.S. Army Institute of Surgical
Research- Series of studies based on Roy’s Adaptation Model.
78. One of the most widely used models in the U. S. for
Geriatric Nurse-Practitioner Program.
University of Ottawa School of Nursing, Canada.
Mount Saint Mary’s College, Los Angeles.
*Source: Fitzpatrick & Wall, 2005
79. *Rogers et al.,1991
A research study explains how one hospital implemented
Roy’ 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.
Chest pain, decreased levels of
activity, fluid overload, sleep
disturbance (physiologic mode)
Fear, anxiety, body image
disturbance due to bypass surgery
others Increased dependency on
Relationship needs unmet
81. *Using Roy's adaptation model when caring for a
group of smoker to quit smoking:
The model served as a guide to assess each
member's level of adaptation in each of the
four modes to identify actual or potential
adaptation problems and then examining the
stimuli that influence those problems. Nursing
interventions focused on approaches to the
management of stimuli to promote adaptation
for the group by helping the members move
to the phase of thinking of quitting smoking.
83. Adaptive modes have unclear
-Interrelated by perception.
Some use of theoretical jargon.
(Lewis, 1988; Patton, 2004)
Abstract and difficult to
Concept of Person as an
Not easily operational for
stimuli create an extensive
list of potential variables.
Addresses all four concepts of a nursing model (metaparadigm)
Comprehensive and systematic assessment.
Focus on the individual.
Person = adaptive system.
86. Widely used in different settings and has
enduring property (based on system’s theory)
Updated as knowledge increases and trends
As one of the weaknesses of the theory that
application of it is time-consuming,
application of the model to emergency
situations requiring quick action is difficult to
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