Nursing Theory: Adaptative Model of Calista Roy

Introduction

Adaptation Theory, Development Theory and General System Theory are all theories of nursing. Roy’s theory is an Adaptation Theory. There are other theorists like Watson who stated that human beings were the central point of all the nursing theories. The nursing theories are further classified according to their theoretical aspects and practicability. Some theories aim at fulfilling the needs of the patients and others emphasize the importance of communication between a patient and a nurse so that recovery can be achieved quickly. This paper will criticize the Roy’s theory which is an adaptation theory.

The birth date of Sister Calista Roy is 1939, and she is from Los Angeles. She has an Arts Degree in Nursing from the college of Mount St. Mary’s College which is in Los Angeles and a Master’s degree also in nursing from California-Los Angeles University. She has also a “Master’s Degree and a Doctorate degree in Sociology”. “She is now a sister in St. Joseph of Carondelet.” Sister Calista Roy worked as a nurse at St. Mary’s Hospital in Tucson, St. Joseph’s Hospital in Lewiston, Idaho and Arizona. She later joined Mount St. Mary’s College in 1996. She helped in coming up with a Master’s program in Nursing. She also participated in the development of a Ph. D. program in Nursing at the Connell School of Nursing (Andrews & Roy, 2007).

Roy’s theory described that a person is both biological and psychological. She further explained that a person lived in an environment which it had an impact on him because he interacted with it. Stressors are as a result of man trying to cope with the environment. Nursing care is therefore important in helping people deal with the stresses and this promotes their well being and health. The nursing theory was developed in 1960s by Roy. She stated that nursing was important in helping patients adapt to the treatments they were given. Roy has received a lot of support from people who practice health care. It asks three questions: Who should be given nursing care? When should one be given nursing care? and “what is the target of nursing care?” The model concepts major on adaptation, the human beings and nursing. Roy suggested that nurses help patients adapt to their illness by giving nursing care.

There are assessments done at different levels by nurses. First, they check if there is maladaptation or no. He or she takes an action that will promote adaptation. Another step is evaluating the progress of the patient. Nurses evaluate if their goals have been achieved or no. The nurses that practice Roy’s theory in their nursing career gives the best quality care to their patients (Chiou, 2009).

Theory Description

Purpose

The purpose of the Roy’s theory was to enhance adaptation. It also aimed at helping nurses to be predicting their nursing experiences. The theory was aimed at guiding nurses and other health care specialists in giving health care. Roy came to realize the importance of nursing and she wanted to share this with the society. She discovered this with her workmate, Dorothy E. Johnson (Dunn, 2006). She first started by organizing the nursing theory while developing a course curriculum. The curriculum was for students who were doing nursing at Mount St. Mary’s College. She then incorporated her ideas in the nursing curriculum.

Roy’s theory was due to deduction because she had clinical experience. She saw that human adaptation was either internal or external (social life). A patient adaptation to health depended on his/her heredity, good atmosphere etc. There are factors that influenced the theory development. These included the family, religious background, education, clinical experience and mentors.

Concepts

The theory’s concepts are health, adaptation, nursing and the environment. Health is defined as a way of life and is sometimes characterized by illness or being whole. It refers to the adaptation of a person with an environment, growth and survival. Roy explains that a person uses mechanisms, the cognator and the regulator to adapt to stimuli of either the external or internal environment (Ducharme, 2010). The mechanisms of cognator are emotions, informational processing, judgment and learning. A person’s goal is to adapt through interaction with the environment. In the environment concept, a person lives in an environment where it had an impact on him because he interacted with it. Stressors are as a result of man trying to cope with the environment. In the nursing concept, nurses bring about adaptation. They improve qualities of life by assessing factors and behaviors that influence the abilities of adapting. Nurses intervene to bring about environmental interactions. This is further explained below.

Definitions

Roy defines her concepts very explicitly. Health is defined as a way of life and is sometimes characterized by illness or being whole. Health refers also to adaptation of a person with an environment, growth and survival. There is a big difference between medicine and health. Medicine refers to treatment of patients while health refers to the adaptation of a person with an environment, growth and survival according to Roy’s model. The adaptive model describes people as in groups, individuals, organizations, families and communities (Taylor, 2010). Society is also included.

In the adaptation concept, there are four modes of adaptation. They facilitate adaptation of a person and they include interdependence mode. In interdependence mode, a patient needs to have a relationship with other people like health care specialist and family members so as to enhance recovery. In the physiological mode, Roy explained that a person ought to be physiologically fit. There is role function mode which Roy explained that people functions according to their positions. The last mode of adaptation is self concept. These are the beliefs of a person which can be either personal or physical.

In the environment concept, Roy’s theory defined the environment as having components and they are three. Focal is one of them which is external or internal and confronts a person. Context is stimuli present mostly in a situation that contribute to focal stimulus. The other component is residual. Its effects in a situation are unknown. Environmental factors are important in nursing because they are indicators of stress in a person. Roy’s explained that a person experiences stress when he/she have failed in copying. This means that his coping mechanisms are not effective when adapting to an environment. A person responds to environmental factors through systems that are biological. They include neurological and endocrine.

In the nursing concept, nursing is defined as promoting adaptation in adaptive mode. The adaptive modes are four and they include physiologic needs, role function, self-concept and interdependence. Nurses enhance adaptation for groups and individuals and hence contribute to health.

They also improve qualities of life by assessing factors and behaviors that influence the abilities of adapting. Nurses intervene to bring about environmental interactions. The adaptive model has six processes of nursing. They include: the level of assessing which addresses the behavior of a patient. The other level of assessing addresses the stimuli of a patient. The third process is of diagnosing the patient. The fourth process is to set goals basically for the health of the patient.

The fifth process is to take maximum actions so as to meet the goals set for the health of the patient. The last process is for evaluating the results so as to determine the achieved goals. Roy argued that, in the whole nursing process, all nurses and health care specialist should incorporate adaptation in their planning of nursing care.

Relationships

The major concepts are health, person, nursing and the environment. They relate to each other in that; a person interacts with environmental changes and later adapts. Illness and health are inevitable in someone’s life and require the attention of a nurse (Yeh, 2007). Roy further explained that a person lives in an environment which has an impact on him because he interacts with it. Stressors are as a result of man trying to cope with the environment. Nursing care is therefore important in helping people deal with the stresses and this promotes their well being and health. Environmental factors are therefore important in nursing because they are indicators of stress in a person. Roy’s explained that a person experiences stress when he/she have failed in copying. This means that his coping mechanisms are not effective when adapting to an environment.

Evaluation

Assumptions

There are explicit and implicit assumptions (values/beliefs). The explicit assumptions are: a person is always in the adaptive mode of trying to cope with the environment. He/she has to employ mechanisms so as to cope with a diverse world. The mechanisms employed have to be acquired, innate, psychological or biological. A person is either sick or in good health and this is a measure of adaptation to a diverse world. A person uses four modes that are for adaptation: self-concept, physiologic needs, interdependence and role function. There is an objective for existing with a goal of wanting to achieve integrity and dignity (Riehl, 2007).

The implicit assumptions are three and they include: a person’s body can be divided into parts for care and study. A patient should be given a chance to speak her/his mind. Finally, adaptation gives liberty to a person’s energy so as to give response to various stimuli.

Metaparadigm

The Roy’s theory has described the four metaparadigm concepts of nursing. They include health, a person, nursing and environment. Health is defined as a way of life and is sometimes characterized by illness or being whole. It refers to also an adaptation of a person in an environment. It also refers to a growth of an individual and his and survival. In the second concept, a person is defined as a bio-psycho-social who constantly interacts with changes of environment. The adaptive model describes a person as either in groups, organizations, families and communities (Taylor, 2010). In the environment concept, Roy’s theory defined the environment as having components and they are three. Focal is one of them which is external or internal and confronts a person. Context is stimuli present mostly in a situation that contribute to focal stimulus. The other component is residual. Its effects in a situation are unknown. Environmental factors are important in nursing because they are indicators of stress in a person. Roy’s explained that a person experiences stress when he/she have failed in copying. This means that his coping mechanisms are not effective when adapting to an environment. A person responds to environmental factors through systems that are biological. They include neurological and endocrine.

In the nursing concept, nursing is defined as promoting adaptation in adaptive mode. The adaptive modes are four and they include physiologic needs, role function, self-concept and interdependence. Nurses enhance adaptation for groups and individuals and hence contribute to health. They also improve qualities of life by assessing factors and behaviors that influence the abilities of adapting. Nurses intervene to bring about environmental interactions. The adaptive model has six processes of nursing. They include: the level of assessing which addresses the behavior of a patient. The other level of assessing addresses the stimuli of a patient. The third process is of diagnosing the patient. The fourth process is to set goals basically for the health of the patient.

The fifth process is to take maximum actions so as to meet the goals set for the health of the patient. The last process is for evaluating the results so as to determine the achieved goals. Roy argued that, in the whole nursing process, all nurses and health care specialist should incorporate adaptation in their planning of nursing care.

The Roy’s theory has elements of nursing because there are nursing questions on it. They include: Who should be given the nursing care? When nursing care should be given? What should be targeted when giving the nursing care?

Clarity

The theory is clear because it links the major concepts of the Roy’s theory. The concepts are health, person, nursing and the environment. They relate to each other in that; a person interacts with environmental changes and later adapts. Illness and health are inevitable in someone’s life and require the attention of a nurse (Yeh, 2007). Roy further explained that a person lives in an environment which has an impact on him because he interacts with it. Stressors are as a result of man trying to cope with the environment. Nursing care is therefore important in helping people deal with the stresses and this promotes their well being and health. Environmental factors are therefore important in nursing because they are indicators of stress in a person. Roy’s explained that a person experiences stress when he/she have failed in copying. This means that his coping mechanisms are not effective when adapting to an environment. Roy shows consistency by giving first the general description of the theory (Zhan, 2011). This is achieved by highlighting the Model’s major concepts which are an adaptation, the human beings and nursing. The purpose of the theory was well elaborated which was to enhance adaptation.

Application

Generality

Roy’s theory can be used in health care, nursing administration and nursing education. It is used generally by nurses to assess the copying of patients to health care. Nurses check if they are copying positively or negatively to focal stimuli. If the adaptations are not promoting health, a nurse will decide which interventions to use so as to enhance adaptation. It is used to help nurses in predicting their nursing experiences. The theory can be used to guide nurses and other health care specialists in giving health care. Generally, the Roy’s theory is used by nurses to assess the history of patients and also their needs. It is used by nurses to determine which resources are best to help patients. Generally, nurses solve their problems using the Roy’s model of adaptation. Therefore, the theory depicts nurses as care givers (Chiou, 2009).

Use

Roy’s theory is used in health care by nurses. The first step of application is evaluation. Nurses check if the patients are copying positively or no to focal stimuli. A nurse evaluates a patient by checking any symptoms shown by a patient. They may include swelling of the body, physical pain experienced by a patient, lack of sleep, if the patient is eating well or not, general outlook, a patient relationship with friends, family members and nurses.

The second step is accessing the cause of a stimulus. Stimuli are at different levels: immediate stimulus is the illness or a wound causing pain to a patient. This is the reason that made the patient go to the hospital. Contextual stimulus is a situation that contributed to illness such as accidents. Residual stimulus is the one whose effects are unknown. The third process of application is diagnosing. After evaluation, a nurse will formulate her findings according to the patient’s condition. An example is a patient who can’t move due to his/her leg amputated. The patient’s leg could have been amputated due an accident when mowing with a mower. The patient could be feeling frustrated due to lack of movement and experience anxiety due to lack of finances.

The fourth step of application is setting goals. Goals can be short-term or long term. A woman hospitalized after falling from a high building and then given a wheelchair can be one of the examples of short-term goals. Long-term goals can be achieved when the woman heals and taken to her home. The other application procedure is intervening. These are steps taken by a nurse so as to achieve her goals. They are steps aimed at helping the patient recover quickly.

The last process is evaluating the progress of the patient. The nurse should evaluate if her goals are being accomplished or no. If her interventions are not promoting health, a nurse will decide which interventions to use so as to enhance adaptation. Other health care specialists also use adaptive mechanisms to determine the health of patient i.e. nutritional state and physical strength. They also use stimuli to assess the family adaptations to major concerns like financial resources (Ducharme, 2010).

Future

If the Roy’s theory will be practiced in the future, it will have good impacts on the health care industry. It will be used by nurses to assess the copying of patients to health care. Upcoming nurses will check if their patients are copying positively or negatively to focal stimuli. If the adaptations are not promoting health, a nurse will decide which interventions to use so as to enhance adaptation. It will be used to help nurses to predict their nursing experiences. The theory will guide nurses and other health care specialists to give health care. It will also be used to assess the history of patients and also their needs. It will be used by nurses to determine which resources are best to help patients. Generally, nurses will solve their problems using the Roy’s model of adaptation. Health care specialists will assess the behaviors and stimuli of patients. They will also set goals basically for the health of the patient. Finally, health care specialist will take maximum actions so as to meet the goals set for the health of the patients

References

Andrews, H., & Roy, C. (2007). The Adaptation Model. Norwalk: Appleton & Lange.

Chiou, C. (2009). A Meta-Analysis of the Interrelationships between the Modes in Roy’s Adaptation Model. Nursing Science Quarterly, 13(3), 252-258.

Dunn, H.C. (2006). The Roy Adaptation Model and its Application to Clinical Nursing Practice. Journal of Ophthalmic Nursing and Technology, 6(2), 74-78.

Ducharme, B. J. (2010). Nursing Theories- The Base for Professional Nursing Practice. (3rd ed). Norwalk: Appleton & Lange.

Taylor, C.L. (2010).The Art & Science of Nursing Care. (4th ed). Philadelphia: Lippincott.

Yeh, C. H. (2007). Adaptation in children with cancer: research with Roy’s model. Nursing Science Quarterly, 14(4), 141-148.

Zhan, L. (2011). Cognitive adaptation: testing Roy’s adaptation model. Nursing Science Quarterly, 13(2), 158-165.