Roy's Adaptation

1
Roy's Adaptation Model
preparedby
Prof. Dr. Nefissa A. El-Kader
Vice Dean of Education and Student
Affairs Faculty of Nursing-Cairo University
2
Outlines

• Origins of the Roys Adaptation Model
• Philosophical claims.
• Scientific Assumptions.
• Strategies for knowledge Development
• Influences from other scholars
• World view
• Major Elements of Roys Adaptation Model.
• The four adaptive modes.
• Nursing activities and nursing process
• Strengths And Weaknesses Of Roys Model

3
Origins of the Roys Adaptation Model

• Dr. Roy credits her major influences in her
  personal and professional growth to her family,
  her religious commitment, and her teachers.
• She earned a Bachelors degree in nursing at
  (1963) Mount St. Mary's College, in Los Angeles.

4
Origins of the Roys Adaptation Model contd.

• She expanded her love and concern for children,
  working in pediatric nursing and soon had the
  opportunity to enroll in a master's degree
  program in pediatric nursing at the University of
  California at Los Angeles (in 1966, she earned a
  masters degree in pediatric nursing and in
  sociology in 1975).
• In 1966 she joined the faculty of Mount St.
  Mary's College, teaching both pediatric and
  maternity nursing and began organizing course
  content according to a view of the person and
  family as adaptive systems.

5
Origins of the Roys Adaptation Model contd.

• In 1968, She began actively introducing her
  ideas about Adaptation Framework to nursing as
  the philosophical basis of the baccalaureate
  nursing curriculum
• Roy first published her conceptual model
• titled Adaptation A conceptual framework for
• nursing, in (1970).
• In (1971 and 1973) she published additional
  elements of model implications for practice and
  education.

6
Origins of the Roys Adaptation Model contd.

• She received input on the use of the model in
  education and practice. By 1987 at least 100,000
  nurses had been educated in programs using the
  Roy Adaptation Model.
• She has also played a key role in at least 30
  research projects. Her current clinical research
  continues her long-time interest in neuroscience.
  
• In 1985, she completed a 2-year postdoctoral
  fellowship in neuroscience science at California
  University.

7
Philosophical claims

• In 1988, Roy published a major paper on her
  philosophical assumptions which characterized by
  the general principles of humanism, holism,
  activity, creativity, purpose, value, mutuality
  and worth of human beings.
• Roy (1987, 1988, 1989) has presented the
  Philosophical claims of the adaptation model in
  the form of scientific and philosophical
  assumptions and values about nursing.

8
Philosophical claims contd

• The scientific assumptions were drawn from
  general system theory (Bertalanffy, 1968)and
  Helsons (1964) adaptation level theory
• The (general system ) theory assumption focused
  primarily on holism, interdependence, control
  processes and information feedback.
• Helson focused on all behavior as adaptive. This
  behavior is the function of both the stimulus
  coming in and the adaptation level.

9
Philosophical claims contd.

• Roy (1992) explained that the model assumes the
  universal importance of promoting adaptation in
  states of health and illness. (Fawcett, 1995).
• By the late 1990s Roy re-defined adaptation for
  the 21 Century. She drew upon expanded insights
  in relating spirituality and science to present a
  new definition of adaptation and related
  scientific and philosophical assumptions

10
Scientific Assumptions

• Explicit

• The person is a bio-psycho-social being.
• The person is in constant interaction with a
  changing
• environment.
• To cope with a changing world, the person uses
  both
• innate and acquired mechanisms, which are
  biologic,
• psychologic, and social in origin.

11
Scientific Assumption contd.

• Explicit

• Health and illness are one inevitable dimension
  of the persons life.
• To respond positively to environmental changes,
  the person must adapt.
• Adaptation is a function of the stimulus a person
  is exposed to and his adaptation level.

12
Scientific Assumption contd.

• Explicit

• The person's adaptation level is such that it
  comprises a zone indicating the range of
  stimulation that will lead to a positive
  response.
• The person is conceptualized as having four modes
  of adaptation physiologic needs, self concept,
  role function, and interdependence relations
  (Meleis, 1991 Fawcett, 1995).

13
Scientific Assumption contd.
Implicit

• A person can be reduced to parts for study and
  care.
• Nursing based on causality.
• Patients values and opinions are to be
  considered and respect.
• A state of adaptation frees an individuals
  energy to respond to other stimuli (Meleis,
  1991).

14
Strategies for knowledge Development

• Roys Adaptation model evolved from a
  combination of inductive and deductive thinking.
• Deductive this approach used by Roy to develop
  her conceptualization of adaptation and the
  factors that influence the level of adaptation.
• Roys conceptualization of the person as an
  adaptive system was deduced from general system
  theory
• Inductive she used this approach to identify the
  four modes of adaptation through classification
  of about 500 samples of behavior of patients
  collected by nursing students over a period of
  several months in all clinical settings.

15
Influences from other Scholars

• Roy was influenced by
• Studies of Social sciences.
• Clinical practice in pediatric nursing
• Dorthy Johnsons focus on behavior.
• Martha Rogers concerns with holistic man.
• Dorothea Orems notion of self-care.
• Work of Helson (1964, Adaptation level theory )
  and Bertalanffy ( 1968, general system theory)
• Nightingale (1859) Peplau (1952).

16
World View

• The Roy Adaptation Model reflects the reciprocal
  interaction world view.
• She repeatedly emphasized the need to view the
  person as a holistic adaptive system that
  function as a whole is more than the mere sum
  of its parts)
• Roy also emphasized the active nature of the
  person (the human system has the capacity to
  adjust effectively to changes in the environment
  and , in turn, affects the environment

17
Major Elements of Roys Adaptation Model

• There are three major elements of Roys
  adaptation model

First Man
Roy develops her concept of manthe client and
the recipient of nursing care
18
Major Elements of Roys Adaptation Model contd.
Second Goal of nursing
Roys model represents the goal of nursing,
which is to promote adaptation through adaptive
modes
19
Major Elements of Roys Adaptation Model contd.
Third Nursing activities
Finally, the model maps the process of nursing
activities, most significant of which are
nursing assessment of client behaviors and
nursing interventions.
20
Concept- Man

• She considers man a biopsychosocial being, who,
  to be properly understood, must be considered as
  a unit or a whole.
• A whole is different from and more than the
  summation of its individual parts.
• Man is an integrated system whose parts have
  relationships among them (adaptive system).
• The recipient of nursing care was identified as
  an adaptive system.
• System is defined as a set of parts connected to
  function as a whole for some purpose.

21
Concept- Man ( cont.)

• The adaptive system has two major internal
  control processes called the regulator and
  cognator subsystems.
• These subsystem are viewed as innate or acquired
  coping mechanisms used by the adaptive system to
  respond to changing internal and external
  environmental stimuli.
• The regulator subsystem responds automatically
  through neural, chemical, and endocrine coping
  processes.
• Stimuli from the internal and external (through
  the senses) act as input to the nervous system.

22
Concept- Man ( Cont.).

• The information is channeled automatically in the
  appropriate manner and an automatic unconscious
  response is produced (Roy ,1991).
• The cognator subsystem responds to inputs from
  external and internal stimuli that involve
  psychological, social , physical and
  physiological factors including regulator
  subsystem outputs.
• Regulator congator activity is manifested
  through coping behavior in four adaptive modes.

23
Man-Environment Interaction

• Man is in constant interaction with his
  environment.
• Since man is a living system, he requires matter,
  energy, and information from his environment.
• The constant interaction of man with his
  environment is characterized by both internal and
  external change. Within this changing world, man
  must maintain the integrity of himself that is,
  he must adapt.
• The internal and external environments ,in the
  form of stimuli, are the inputs into the adaptive
  system.
• Roy identified three classes of stimuli (focal,
  contextual and residual).

24
Adaptation

• Man copes with environmental change through
  biopsychosocial adaptive mechanisms.
• Some adaptive mechanisms are inherited or genetic
  processes, the white blood cell defense system
  against bacteria seeking to invade the body.
• Other mechanisms are learned, such as the use of
  antiseptics to cleanse a wound.

25
Health-concept

• Health is a state of human functioning whereby
  the person continually adapts to change.
• According to Roy health can be viewed along a
  continuum that flows from death and extreme poor
  health, through poor health, to a midpoint of
  normal health.
• The health continuum moves from this midpoint to
  good health , to high- level wellness, to peak
  health.

26
Adaptation contd.
27
Adaptation Level

• Significance factors of adaptation
• The degree of environmental change.
• 2. The state of the persons coping.

28
Adaptation Level contd.

• Environmental changes include snow, temperature
  change, presence of a virus, radiation from a
  nuclear explosion, and industrial pollution.
• Environmental change interfaces with the
• individuals state of coping.
• The condition of the person or his state of
  coping is his adaptation level.

29
Adaptation Level contd.

• The individuals adaptation level will determine
  whether a positive response to internal or
  external environmental will be elicited .
• The individuals adaptation level is determined
  by the focal, contextual, and residual stimuli.
  In any environment-human interaction, the
  environ-mental change is the focal stimulus.

30
Adaptation Level contd.

• Contextual stimuli are all other stimuli of the
  persons internal or external world that
  influence the situation and are measurable or
  reported by the person.
• Residual stimuli are the makeup or
  characteristics of the individual that are
  present and relevant to the situation but are
  difficult to measure objectively.

31
Adaptation Level contd.
32
Modes of Adaptation

• Roy identifies four distinct modes or ways of
  adapting by which man responds to change

1- Physiological Needs Mode
The physiological adaptive mode relates to the
need for physiological integrity as Exercise
and rest, nutrition and elimination, fluid and
electrolytes, oxygen and circulation, regulation
of temperature, regulation of senses, and
regulation of the endocrine systems.
33
Modes of Adaptation contd.
1- Physiological Needs Mode
Adaptation occurs as the individual maintains his
integrity through positive response to need
deficits or excesses
34
Modes of Adaptation contd.
2- Self-Concept Mode

• Self-concept defined as the composite of
  believes and feelings that a person holds about
  him/herself at a given time.
• Roy states that the psychological integrity of
  the
• individual is an inner requirement or need.
• This view is likened to Talcott Parsonss view of
  the
• human personality as a system.,

35
Modes of Adaptation contd.
2- Self-Concept Mode

• The personality system has the need to maintain
  its integrity, which Parsons identifies as system
  adaptation, goal attainment, integration, and
  pattern-maintenance.

36
Modes of Adaptation contd.
2- Self-Concept Mode

• The self-concept encompasses perceptions of the
  physical and the person self.
• The physical-self deals with the body sensation
  and body image. Body sensation refers to how
  one feels experiences oneself as a physical
  being .
• The personal self encompasses self consistency,
  self-ideal and the moral- ethical spiritual
  self.

37
Modes of Adaptation contd.

• Self-consistency refers to the striving to
  maintain a consistent self- organization and to
  avoid disequilibrium.
• Self-ideal refers to what one like to be or is
  capable of doing.
• The moral-ethical- spiritual self encompasses
  ones belief system evaluation of who one is.

38
Modes of Adaptation contd.
3- Role Function Mode

• Interpersonal interaction satisfies the humans
  need
• to identify the self in relation to others.
• The response of others to the self shapes and
• reshapes ones behavior

39
Modes of Adaptation contd.
3- Role Function Mode

• Social interaction occurs within the contexts
• of family, groups, community, and society.
• Rules of behavior / limits of behavior, will be
  set
• that guide ones actions.
• Behavioral rules or limits that are common within
  a society are called norms.

40
Modes of Adaptation contd.
4- Interpersonal Mode

• Social integrity for an individual requires more
  
• than just the proper performance of roles in
  social
• situations.
• The individual acts in ways that will result in
• satisfying his needs for love and support.
  Through
• interdependence ones life gains meaning and
  purpose.
• Interdependence is a balance between dependence
• and independence

41
Nursing concept

• Roy (1976) defined nursing as a theoretical
  system of knowledge which prescribes a process of
  analysis and action related to the care of the
  ill or potentially ill person.
• Furthermore , nursing is a scientific discipline
  that is practice oriented (Roy 1991)
• The model stipulates that a nurse is needed
  when unusual stresses or weakened coping
  mechanisms make the persons usual attempts to
  cope ineffective.

42
Nursing concept

• Nursing focuses on the person as a total being
  who responds to internal and external stimuli
• ( Roy , 1970)
• The goal of nursing is the promotion of
  adaptation in each of the four ( adaptive modes
  contributing to the persons health , quality of
  life and dying with dignity

43
Content of the Model propositions

• The metapardigm concepts of person, environment,
  and health are linked in the following
  statements
• The changing environment stimulates the person to
  make adaptive responses. The person is described
  as an adaptive system consistently growing and
  developing within a changing environment (
  Andrews and Roy, 1991)
• A persons health can be described as a
  reflection of this interaction or adaptation (
  Andrews and Roy, 1991)

44
Content of the Model propositions contd.

• The metapridgm concepts of person, health , and
  nursing are linked the following statements
• The goal of nursing is the promotion of
  adaptation in each of the four adaptive modes,
  thereby contributing to the persons health,
  quality of life, and dying with dignity ( Andrews
  and Roy, 1991)
• The goal of nursing intervention is to maintain
  and enhance adaptive behaviors and to change
  ineffective behavior to adaptive ( Andrews and
  Roy, 1991)

45
Content of the Model propositions contd.

• The linkages of all four metapardigm concepts are
  presented in this statement
• It is the nurses role to promote adaptation in
  situation of health and illness to enhance the
  interaction of the person with the environment,
  thereby promoting adaptation (Andrews and Roy,
  1991)

46
Nursing activities and nursing process.

• The nurse, in her first level assessment,
  observes the for signs of autonomic activity,
  signs that invariably are present when the
  individuals biopsychsocial integrity is
  threatened.
• The client is the first to be aware of coping
  failure. Maladaptive behavior as well as adaptive
  behavior requiring support becomes the focus of
  the nurse.
• Second level assessment, identify the focal,
  contextual, and residual stimuli that combine to
  determine the individual's adaptation level.

47
Nursing activities and nursing process contd.

• The second level assessment leads the nurse to
  identify the adaptation problems. This process is
  referred to nursing diagnosis.
• Intervention Roy developed nursing intervention
  as attempt to manipulate the environment by
  removing, increasing, decreasing, and/or altering
  stimuli for promoting movement toward peak health
  and meeting the individual's needs of biological,
  social, and psychological integrity.
• The nurse concludes the nursing process with an
  evaluation of the effectiveness of the nursing
  intervention in the client goal achievement.

48
Roys Adaptation Model
Interaction Capsulate
Acquired Physiological Role function Self-concep
t Interdependence Adaptation Process Innate
Output
Input
Behavioral Responses Adaptive or Ineffective
Environmental Changes External Internal
Focal Contextual Residual
Feedback Figure 14-3 The person as an adaptive
system.
49
Strengths And WeaknessesOf Roys Model
Strengths of Roys Model

• It guides the nurse to utilize observation and
  interviewing skills in doing an individualized
  assessment of each client. Behavior related to
  the four adaptive modes is collected during the
  first level assessment. Physiological needs,
  self-concept, role function, and
  interdependence.

50
Strengths And Weaknessesof Roys Model contd.
Strengths of Roys Model

• The close association between intervention
  strategies and assessment data may clarify for
  the nurse the importance of individualized
  assessment of each client individually.
• The model also suggests that after assessment,
  the nurse is to make judgments regarding the
  clients adaptation through the four adaptive
  modes in relation to need excesses or deficits
  that are created secondary to environmental
  change.

51
Strengths And Weaknessesof Roys Model contd.
Weaknesses of Roys Model

• Roy fails, however, to define or operationalize
• these concepts (4 adaptive modes) .
• Question the association that is drawn between
• need deficits or excesses created by a threat
  to
• integrity and the behavioral manifestation of
  that
• need in the adaptive mode.

52
Strengths And Weaknessesof Roys Model contd.
Weaknesses of Roys Model
How can the nurse be sure that observed behavior
related to an adaptive mode represents a need
deficit identified by the model since need
deficits or excesses are not directly observable?
53
Strengths And Weaknessesof Roys Model contd.
Weaknesses of Roys Model

• The major assumption of the model that man is a
  biopsychosocial being by nature. Does this
  conceptual approach truly reflect the nature of
  mans relationship with his environment?
• Only further research of the model can give us
• this answer.

54
Thank You