Roy's Adaptation Model of Nursing

The Adaptation Model of Nursing was developed by Sister Callista Roy in 1976. After working with Dorothy E. Johnson, Roy became convinced of the importance of describing the nature of nursing as a service to society. This prompted her to begin developing her model with the goal of nursing being to promote adaptation. She first began organizing her theory of nursing as she developed course curriculum for nursing students at Mount St. Mary’s College. She introduced her ideas as a basis for an integrated nursing curriculum.

The factors that influenced the development of the model included: family, education, religious background, mentors, and clinical experience. Roy’s model asks the questions:

  • Who is the focus of nursing care?
  • What is the target of nursing care?
  • When is nursing care indicated?

Roy explained that adaptation occurs when people respond positively to environmental changes, and it is the process and outcome of individuals and groups who use conscious awareness, self-reflection, and choice to create human and environmental integration.

The key concepts of Roy’s Adaptation Model are made up of four components: person, health, environment, and nursing.

According to Roy’s model, a person is a bio-psycho-social being in constant interaction with a changing environment. He or she uses innate and acquired mechanisms to adapt. The model includes people as individuals, as well as in groups such as families, organizations, and communities. This also includes society as a whole.

The Adaptation Model states that health is an inevitable dimension of a person’s life, and is represented by a health-illness continuum. Health is also described as a state and process of being and becoming integrated and whole.

The environment has three components: focal, which is internal or external and immediately confronts the person; contextual, which is all stimuli present in the situation that all contribute to the effect of the focal stimulus; and residual, whose effects in the current situation are unclear. All conditions, circumstances, and influences surrounding and affecting the development and behavior of people and groups with particular consideration of mutuality of person and earth resources, including focal, contextual, and residual stimuli.

The model includes two subsystems, as well. The cognator subsystem is a major coping process involving four cognitive-emotive channels: perceptual and information processing, learning, judgment, and emotion. The regulator subsystem is a basic type of adaptive process that responds automatically through neural, chemical, and endocrine coping channels.

The Adaptive Model makes ten explicit assumptions:

  1. The person is a bio-psycho-social being.
  2. The person is in constant interaction with a changing environment.
  3. To cope with a changing world, a person uses coping mechanisms, both innate and acquired, which are biological, psychological, and social in origin.
  4. Health and illness are inevitable dimensions of a person’s life.
  5. In order to respond positively to environmental changes, a person must adapt.
  6. A person’s adaptation is a function of the stimulus he is exposed to and his adaptation level.
  7. The person’s adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response.
  8. The person has four modes of adaptation: physiologic needs, self-concept, role function, and interdependence.
  9. Nursing accepts the humanistic approach of valuing others’ opinions and perspectives. Interpersonal relations are an integral part of nursing.
  10. There is a dynamic objective for existence with the ultimate goal of achieving dignity and integrity.

There are also four implicit assumptions which state:

  1. A person can be reduced to parts for study and care.
  2. Nursing is based on causality.
  3. A patient’s values and opinions should be considered and respected.
  4. A state of adaptation frees a person’s energy to respond to other stimuli.

The goal of nursing is to promote adaptation in the four adaptive modes. Nurses also promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions. The Four Adaptive Modes of Roy’s Adaptation Model are physiologic needs, self-concept, role function, and interdependence.

The Adaptation Model includes a six-step nursing process.

  1. The first level of assessment, which addresses the patient’s behavior
  2. The second level of assessment, which addresses the patient’s stimuli
  3. Diagnosis of the patient
  4. Setting goals for the patient’s health
  5. Intervention to take actions in order to meet those goals
  6. Evaluation of the result to determine if goals were met

Throughout the nursing process, the nurse and other health care professionals should make adaptations to the nursing care plan based on the patient’s progress toward health.