Theory and Theorist Background of Callista Roy’s Adaptation Model
This research paper seeks to describe and evaluate the Roy’s Adaptation Model as well as discuss its applicability in nursing. Callista Roy first developed the model as a conceptual framework, when Dorothy Johnson challenged her to do so for a seminar at the University of California. Her life and nursing experience, rich education background, and the support of her mentors together with the influence of her religious family, especially her mother who helped her foster the values, provided a sufficient background not only for her nursing career, but also for the development of the model. The model defines and describes the four major concepts (metaparadigms) of nursing, health, environment, and person, all of which are interrelated with the concept of adaptation. The person (biopsychosocial being) interacts with the ever-changing environment full of stimuli. The four modes of adaptation include self-concept, interdependence, physiological side, and role function. The explanation and definition of the concepts, the four modes of adaptation, and the explicit and implicit philosophical assumptions are clearly established. This model is applicable in nursing research, education, and practice. The nursing process helps nurses assess the person and make a diagnosis before implementing the effective adaptation to improve health.
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The nursing profession is unique because it relies on theories that form a rich base of knowledge, guiding not only its practice, but also research and education. Harnegie (2015) explains that unless the practice of nursing is based on sound theoretical foundations, nursing will never be a profession. This shows that utilizing theoretical frameworks and approaches gives direction to various fields of the profession, including practice and education among others. Theories are created when a need arises to give meaning or organize facts, observations, and complex problems that affect people and the community as a whole (Portney & Watkins, 2015). Other than guiding nursing practice and education, nursing theories provide explanations for research findings through the examination of the already known issues or concepts, considering either failure or success of previous research studies. Callista Roy’s Adaptation Model is one of the major grand theories of nursing that implicates nursing practice, research, management, informatics, and education. This research paper will describe, evaluate, and discuss the application of Roy’s Adaptation Model in Nursing.
Callista Roy is a respected nurse researcher, theorist, lecturer, and teacher who has immensely contributed to the field of nursing. She formulated the adaptation model which was named after her as Roy’s Adaptation Model. Currently, Roy is a nursing professor and theorist in the renowned Connell School of Nursing in Boston (Smith & Parker, 2015). She holds many appointments as a professor of nursing research in various institutions, including Mt. Saint Mary’s College among many others. She has been a serious member of the Sisters of St. Joseph of Carondolet for a period exceeding 50 years (Smith & Parker, 2015). Roy is an outstanding individual who has influenced the nursing profession and its operations, and is considered to be the living legend with great thinking ability (Smith & Parker, 2015). It is the outstanding performance in her professional work that has earned her a significant recognition and respect in the nursing arena.
Roy’s education background further reveals her excellent performance, proving that her skills and knowledge can not be underestimated. Roy obtained her Bachelor of Arts degree with a nursing major from Mount St. Mary’s College, in Los Angeles (Smith & Parker, 2015). She later acquired her Master of Education in both pediatric nursing and sociology before pursuing a doctoral education at the University of California in Los Angeles. She then completed a two-year postdoctoral program in neuroscience nursing as a clinical nurse scholar at the University of California in San Francisco. In Australia, Roy was also a Senior Fulbright Scholar. She attributes her success in education and the nursing career to her life mentors, including Dorothy Johnson who sparked the development of the adaptation theory, Ruth Wu, and Connie Robinson among many others (Smith & Parker, 2015). The knowledge acquired from both the field of nursing and sociology has substantially contributed to her performance not only in education, but also in research.
Roy’s life experiences have also significantly contributed to the creation of the adaptation model. Roy believes she was mainly influenced by her religious environment, her family, teachers, and mentors (Smith & Parker, 2015). She was born in 1939 in Los Angeles, as the oldest daughter of the family with fourteen siblings seven of which were males while the remaining ones were females (Smith & Parker, 2015). Being born in a religious family, a deep spirit of love, hope, faith, service to others, and commitment to God was central to all members of the family. Roy’s mother has also made a significant contribution to her daughter’s success, because she was a licensed vocational nurse who taught Roy about the moral values. She encouraged her to tirelessly seek new knowledge about human beings and their care, as well as to be selfless and giving as a professional nurse (Smith & Parker, 2015). Another great motivation came from Dorothy Johnson who challenged Roy to create a conceptual model in a seminar at the University of California (Fawcett & Desanto-Madeya, 2012). Roy had no option other than to come up with a model that finally became the adaptation theory of nursing. Her experience when working as a pediatric nurse provided her with an insight in regard to what issues the model would discuss. She observed the resiliency of children and realized that their ability to adapt was both due to psychological and physical changes in the environment. It was this observation, her experience, and the challenge posed by Johnson that motivated Roy to start developing the Adaptation Model.
Many scholars, including Roy herself, have written a lot about the original model, resulting in its modifications since its inception. Roy explains that the model creation began in 1964 after Johnson’s challenge and has been undergoing modifications up until 1968, when she started working with scholars to incorporate this model into the nursing curriculum (Fawcett & Desanto-Madeya, 2012). The development of the adaptation model continued in the 1970s, when the researches of other scholars, students, and Roy’s workmates further refined and clarified its concepts. Nursing Knowledge Development and Clinical Practice by Roy and Jones in 2007 and The Roy Adaptation Model by Roy in 2009 are her most significant publications written about the original model after making the modifications (Smith & Parker, 2015, p. 154). Fawcett and Desanto-Madeya (2012) explain that many scholars have researched the model and made many publications. Therefore, both Roy and other scholars have written much about the model since its creation.
The Roy’s model addressed the patient response to environmental stimuli that impact health, and the role of the nurse in enhancing patient adaptation as an element of concern. The model identifies four concepts of adaptation that include nursing, health, environment, and the person (Fawcett & Desanto-Madeya, 2012). Roy further explains that health and illness are inevitable while environmental adaptation happens in the presence of environmental stimuli. On the same line, self-concept, role function, interdependence, and physiological needs comprise the four modes of adaptation, and the role of nursing is to promote adaptation in the four modes while upholding patient values and opinions (Roy, 2013). The function of the nurse adds value to health, quality of life, as well as dying with dignity through both behavioral assessment and many other factors that influence the adaptive abilities.
The Roy’s Adaptation Model is both inductive and deductive. The model is inductive because Roy developed all the four modes of adaptation based on both her research and practice experiences as well as on those of her colleagues and students (Alligood, 2014). Her efforts helped her develop the conceptual framework of adaptation that nurses use in practice while delivering healthcare services. The theory is deductive because it utilizes the knowledge collected from fields outside nursing. Alligood (2014) stated that the adaptation model is deductive because it derives its origin from the psychophysics theory of Helson. Helson developed residual stimuli, focal, and contextual concepts that Callista Roy redefined by forming a typology of factors related to the levels of adaptation in nursing. Therefore, the deductive nature of this theory comes from the fact that Roy utilized knowledge from other fields of knowledge to formulate her model.
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The theory explicitly defines and explains its major theoretical concepts. The concepts include the person or groups of people as adaptive systems, while the environment, health, and nursing are factors that aim to promote adaptation (Smith & Parker, 2015). Roy asserts that a person or group of individuals are holistic adaptive systems with coping processes aimed to maintain adaptation. Adaptation occurs through physiological issues, role functions, interdependence, and self-concept modes of adaptation when reacting to the environment, which refers to both internal and external surroundings that affect the stability of the person’s system (Roy, 2013). The environment has three main types of stimuli that confront the person, and they include focal, contextual, and residual stimuli (Smith & Parker, 2015). Focal stimuli are those that directly confront the person. The contextual stimuli refer to the factors contributing to the focal stimuli, while the residual stimuli are the unknown environmental stimuli influencing situations (Smith & Parker, 2015). Therefore, the person interacts with the environment that has several internal and external stimuli.
Health and illness or a disease are all interrelated, so the nurse promotes adaptation in order to enhance health. Smith and Parker (2015) explain that the concept of health is related to adaptation concept, and adaptive response plays a critical role in promoting integrity. The coping process is classified into two separate processes, known as cognator and regular (Roy, 2013). A person automatically reacts to environmental stimuli through physiological processes involving endocrine, neural, and chemical channels, using the regulator subsystems, while cognator reactions occur through the cognitive and emotional channels. The role of nursing is to promote the effective adaptation in the four modes through the assessments and interventions in order to manage stimuli (Roy, 2013). This indicates that the nurse operates to enhance the meeting of the desired goals of adaptation to improve health, quality of life, and help to die with dignity.
The major concepts of the Roy’s Adaptation Model are interrelated with clearly explained propositions. Alligood (2014) explains that the model dwells on the concept of adaptation and the concepts of person, health, environment, and nursing are interrelated with this concept. The person always interacts with environmental stimuli, and adaptation is the ultimate response. Health comes in when the interaction affects wellness, sometimes due to maladaptive processes that may cause diseases. Nursing aims to assist the person in adapting effectively to the prevailing environmental stimuli by manipulating the environment in order to achieve an optimal level of wellness (Alligood, 2014). Therefore, all the concepts show cohesive interrelationships.
The adaptation model makes both implicit and explicit assumptions. Explicitly, Roy asserts that the person is a bio-psychosocial being who constantly interacts with the ever-changing environment (Roy, 2013). The person employs both innate and acquired coping mechanisms to respond to changes in the environment positively, and adaptation is a reaction to the stimuli interacting with an individual. Furthermore, the theory assumes that health and illness are inevitable dimensions in the life of the person. Most importantly, the person has the modes of adaptation including physiologic needs, role functions, self-concept, and interdependence. Roy nursing takes a humanistic approach to valuing the opinions and perspective of others with an ultimate goal of achieving integrity and dignity. On the other hand, the theory also makes implicit assumptions. According to Smith and Parker (2015), the person can be reduced to being an object for care and study, while nursing is based on causality. Moreover, consideration and respect of values and opinions of the patient should be of paramount importance.
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The Roy’s model comprehensively describes the four concepts of nursing metaparadigms. The model defines nursing as the science and practice, which expands the abilities to adapt and enhances environmental and personal transformations (Roy & Roy Adaptation Association, 2014). The nurse promotes adaptation when the person interacts with environmental stimuli. The person is a holistic system that interacts with the environment. On the other hand, the environment refers to all circumstances, conditions, and influences that surround and impact the development and behavior of the person. The effect of the environment on the individual comes from the environmental focal, contextual, and residual stimuli. Alligood (2014) explains that according to Roy’s model, health is a state and process of being and becoming an integrated whole. In short, it is a reflection of the adaptive responses between the person and environmental factors.
The clarity of the model is unquestionable. Roy has clearly defined all the medaparadigm concepts of the theory as well as the four modes of adaptation (Alligood, 2014). Furthermore, the model proceeds to establish that the individual interacts with the environment as a whole. The clarity of the interrelationships between the concepts is also established, and the assumptions underlying this model are clear. Therefore, the model upholds clarity.
The theory guides nursing actions in education, research, and practice. In nursing research, the theory can guide the performance of various activities. For example, Afrasiabifar, Karimi, and Hassani (2013) utilized Roy's adaptation model to formulate research questions and collect data through the utilization of the questionnaire. Also, the research findings can be compared to the RAM in order to draw comparisons before making conclusions and recommendations. Additionally, Afrasiabifar, Karimi, and Hassani (2013) utilized the model as a framework to guide their research, meaning that the theory provides a framework for many nursing research studies. The model is also incorporated in the nursing curriculum to guide students who want to practice nursing, particularly in regard to the role of nursing in the promotion of health through enhancing the effective adaptation of the person (Alligood, 2014). The model, therefore, guides nursing research through the provision of frameworks, and nursing education through the provision of content for the curriculum in addition to guiding students to learn everything about their role as future nurses in the healthcare system.
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Most importantly, the model guides nursing practice because it clearly stipulates the role of the nurse in health promotion through carrying out actions to modify the environment and promote adaptation in the presence of environmental stimuli. In nursing practice, nurses can use this model to guide their practice in assessing the patient or groups of patients and communities in order to identify environmental stimuli that impact health before promoting effective adaptation. Furthermore, the model can help nurses formulate a comprehensive care plan to guide their actions while providing quality healthcare services. In their study, Alimohammadi, Maleki, Shahriari, and Chitsaz (2015) found that the biological dimension care plan based on this model increased physiological adaptation among patients recovering after a stroke. Rogers and Keller (2009) further explain that Roy's model allows conducting the examination of physical activity, as well as the development of theory-based interventions from the expanded, integrated, and holistic nursing perspective. Therefore, the theory guides various actions in the practice of nursing.
In my area of nursing practice, I can utilize this model in assessing patients, identifying any deviations from normalcy, and implementing nursing interventions to promote the health of my patients by correcting these deviations. Roy and Roy Adaptation Association (2014) explain that the adaptation model includes a six-step nursing process that includes assessment of patient's behavior and environmental stimuli, diagnosis, setting of goals of treatment, interventions to achieve the goals, and evaluation of the results of the interventions. In practice, I will employ this model to identify all the stimuli that cause disease before making a diagnosis. Helping the patients adapt well through offering effective therapies such as medical, social, and psychological therapies among many others will in turn help them adapt to the four modes of adaptation. Most importantly, I will evaluate my care to ascertain its effectiveness and make appropriate changes in order to achieve the optimal, desired outcomes.
The Roy’s Adaptation Model has influenced the nursing profession because its concepts and assumptions guide various actions of nursing. Many factors contributed to the development of the theory. Coming from a religious family, having a mother who was a nurse with certain values, being influenced by the experience, education, and most importantly by mentors have motivated Callista Roy to create and formulate the adaptation model of nursing. The model clearly explains the concepts of the environment, nursing, person, and health, which are the four nursing metaparadisms. These concepts relate to the concept of adaptation to the environment that is full of stimuli. Other than having deductive and inductive features, the model makes both implicit and explicit assumptions. Clarity is upheld in the way Roy defines and describes the major concepts, the four modes of adaptation, and the philosophical assumptions. The model has immense significance because it impacts nursing education, research, and practice. In my case, the theory will guide my actions during the nursing process in order to help me provide quality nursing care to my patients.