Sister Callista Roy

• Born in Los Angeles, California, on October 14, 1939

• Second child of Mr. and Mrs. Fabien Roy

• Family of seven boys and seven girls

• She was named after Saint Callistus of the Roman Catholic Calendar.

• Mother was a licensed vocational nurse

Education• Bachelors Degree in Nursing from

Mount St. Mary’s College in 1963.• Masters in Pediatric Nursing from

University of California in 1966• Suffered with Encephalomyelitis,

a neurological disorder.

• Second Masters and PhD in

Sociology in 1973 and 1977

• She finished her postdoctoral

program in Neuroscience

Nursing.

Professional Experience• Started at age 14.• Pediatric Nurse• Nursing instructor in

many different capacities.

• Currently she is the Professor and Nurse Theorist at the William F. Connell School of Nursing, Boston College.

Personal and Professional Influences• Her family, mainly her

mother• Her religious beliefs– She became a member of

the Sister Of Saint Joseph of Carondelet

• Her teachers and mentors• Dr. Dorothy Johnson– Challenged Ms. Roy to

develop herNursing theory.

Introduction of The Model/Theory

• Adaptation was first introduced to Ms. Roy in apsychology class

• Adaptation of children• Theory development

started in 1964• First utilized in Mount St.

Mary’s College

Roy’s Adaptation Model

• Developed over the years• Supported through research• 163 Research studies

conducted• Has been in use for 46

years.• Published in various

languages.• Internationally used.

The central questions of Roy’s theory are:– Who is the focus of nursing care?– What is the target of nursing care?– When is nursing care indicated?

• Roy’s first ideas appeared in a graduate paper written at UCLA in 1964.

• Published these ideas in "Nursing outlook" in 1970• Subsequently different components of her framework

crystallized during 1970s, ’80s, and ’90s• Over the years she identified assumptions on which

her theory is based.

• Systems of matter and energy progress to higher levels of complex self-organization

• Consciousness and meaning are constitutive of person and environment integration

• Awareness of self and environment is rooted in thinking and feeling• Humans by their decisions are accountable for the integration of creative

processes• Thinking and feeling mediate human action• System relationships include acceptance, protection, and fostering of

interdependence• Persons and the earth have common patterns and integral relationships• Persons and environment transformations are crated in human consciousness• Integration of human and environment meanings results in adaptation

• Persons have mutual relationships with the world and God• Human meaning is rooted in an omega point convergence of the universe• God is intimately revealed in the diversity of creation and is the common destiny

of creation• Persons use human creative abilities of awareness, enlightenment, and faith• Persons are accountable for the processes of deriving, sustaining, and

transforming the universe

Roy’s Adaptation Model: Demonstration of Theory Integration into Process of Care in Coronary Care Unit

This article describes a case study involving a process of theory integration into nursing care in a cardiac care setting. This approach was guided by Roy’s adaptation model from the totality paradigm. Following a brief overview of practice methodology of Roy’s Adaptation Model, a two-level assessment is conducted for a cardiac patient. Based on the two-level assessment nursing diagnosis is established and nursing interventions are planned which aim to promote adaptation.Various nursing strategies are described which help the patient to move towards the direction of adaptation. The research support of the theory and proposed research to support the theory is also mentioned.

Theory-based nursing practice is entrenched in the concept that the work of any discipline is directed by its knowledge base. The practice then is guided by the distinctive theories of that particular discipline. A practitioner using process of theory-based nursing practice develops a practice proposition and a plan for schematic application of this nursing process in the relevant area of nursing. This article will present an example of this process using Roy’s Adaptation Model (RAM). The purpose of this article is to demonstrate theory integration into the process of care for a CVAS patient.

• RAM assumes that the basis of nursing knowledge is founded upon an understanding of people adapting within their given life situations. Roy identifies three elements in her model of nursing: the recipient of nursing, the goal of nursing, and nursing intervention.

• Each of these essential elements includes the concepts of nursing, person, health-illness, environment, and adaptation. The concept of adaptation assumes that people are open systems who respond to stimuli from both outside and inside of the person (Roy & Andrew,

• 1991).• The use of RAM in a patient with CVA will illustrate how a nurse can promote a client’s

adjustment to challenges related to health and illness. In this theory, adjustment refers to adaptation, and challenges refer to stimuli. This theoretical model incorporates information from many fields into nursing.

• RAM includes a detailed nursing process, which involves assessing client behaviors and their influencing factors, identifying problems, setting goals, selecting interventions, and evaluating outcomes in order to provide comprehensive nursing. The nurse’s role while caring for a patient involves manipulating the stimuli that comes from the environment so that they fall within the client’s field of positive coping resulting in adaptation. The adaptation is considered as the positive response to a stimulus, whereas a negative response is described as mal-adaptation (Tolson & McIntosh, 1996).

Mr. B.E.., a 60-year-old man, was diagnosed to have post-infarct seizure, status post Cerebrovascular Accident. This patient had several hospital admissions over the last few months. He was also an insulin dependent diabetic for the last 20 years.

Physical examination revealed blood pressure of 200/130 mm of Hg, a regular pulse of 100-110 beats per minute, and respirations of 28 per minute.

• In first level assessment, adaptive responses in all four modes were examined. In physiological mode the patient’s ineffective adaptation i.e., unstable vital signs, was the first priority for nursing care. The patient was alert, oriented, and was able to speak indicating that her central neurological functioning was intact.

• Adaptation problems that were observed during assessment included: hemodynamic instability, sleep deprivation, activity intolerance, and elimination. Assessment of the self-concept mode revealed, grieving over loss of regular physical activity. Mrs. T. cried frequently and seemed depressed. While assessing the role functioning mode, it was noticed that Mrs. T. was having difficulty accepting her role as a patient. She did not understand the importance of the intravenous medication infusions. In addition, She was upset with the MD who inserted central line as she thought she did not need it. Moreover, she felt that all these treatments were making her sicker. She also refused assistance with personal hygiene, but was unable to do it unaided. During assessment of interdependence mode, no ineffective adaptive responses were noted as patient had good family support.

• In second level assessment, the level of focal, contextual, and residual stimuli influencing Mrs. T’s ineffective behavior were examined. The focal stimulus identified was: poor left ventricular function causing congestive heart failure and resultant impact on maintaining optimum cardiac output, vital signs, and tolerance to regular physical activities.

• Contextual stimuli included: anxiety due to illness and fear of the unknown. Residual stimuli influencing Mrs. T’s ineffective behavior were identified as: personality traits, her valuing of independence, possible residual effects from her previous hospitalization, memories of past experiences, and past patterns of relating and coping.

• The use of Roy Adaptation Model of Nursing enhances nursing care on a CVA patient. Implementing this model in practice is perceived as having a positive impact on personal sense of nurses as well as on the image of nursing profession as a whole. The model is found effective in providing direction towards achieving patient outcomes. According to the writer, the introduction of the model on a CVA patient made a positive difference in quality of patient care, primarily due to the comprehensive approach to assessment and planning. In the clinical care setting, the model concepts were more easily incorporated in to practice than the actual language of the model. A several stimuli which are affecting the person from the internal and external environment in four different modes of adaptation are being managed by nursing interventions. The stimuli are shown as aiming to affect person’s equilibrium, but with appropriate nursing interventions, they are diverted away from the patient, and effective adaptation is achieved. Overall, this model provides a structure for focusing, organizing, and directing thoughts and actions related to patient care and for achieving, desired patient outcomes efficiently and effectively.

• Provide an opportunity for consideration of multiple aspects of the human adaptive system and support gaining an understanding of the whole system

• The importance of the spiritual aspects of the human adaptive system, often omitted from nursing assessment, is included in a manner that allows for incorporation of spiritually without imposition of the nurses beliefs.

• Logically organized and draws on the nurses observational and interviewing skills.

• The need for consistent definitions of the concepts and terms within the RAM

• In practice area, it is increasinglychallenged with time constraints, the amountof time required to fully implement the twoareas of RAM assessment may be viewed as insurmountable

• The Roy adaptation model identifies the essential concepts relevant to nursing as the human adaptive system is viewed as constantly interacting with internal and external environmental stimuli.

• The human adaptive system is active and reactive to these stimuli.

• Stimuli are defined as focal(regular stimuli), contextual(stimuli existing in situation) and residual (other phenomena arising from a person’s internal or external environment that may affect the local stimuli but the effects are unknown).

• The internal coping processes of regulator and cognator for the individual and stabilizer and innovation for collective human adaptive systems are phenomena of concern to nursing.

• Support of coping processes may be the focus of nursing intervention. The fouradaptive modes may be the first aspect of the model that the student or nurse is able to assimilate.