Sister Callista Roy’s Adaptation Model (RAM) is representative of a grand nursing theory whose conceptual framework is focused on the interconnected, holistic individual and his/her interaction with the environment. As McEwen (2011) outlines, the foundation for Roy’s theory can be attributed to several individuals including Helson, von Bertalanffy, Rapport, Lazarus, and most significantly to Dorothy Johnson’s model for behavioral systems.  Roy also combines spirituality within her model to illustrate how adaptation is integrated with health through four modes of functioning including psychological, self-concept, role function and interdependence (Tourville, C. and Ingalls, K, 2003). According to Roy, adaptation is the outcome observed when responses to environmental changes are positively experienced. As described by Tourville and Ingalls (2003), Roy’s model is based on the assertion that a person’s ability to adapt is a “positive response” for life development and maturity related to physical needs and quality of life.  

MAJOR METAPARADIGM CONCEPTS 

The metaparadigm concepts embedded within the RAM include person, environment, nursing and health.  There is a constant interaction on many levels allowing individuals and groups (including  families, communities, etc.) mutability and transformation.  Utilizing the nursing process, nurses can assess for “maladaptive behaviors” and develop care plans with interventions that augment adaptation positively for improved outcomes (Kenney, 2013, p.368).

·        Person – defined as “a whole with parts that function as a unity for some purpose” (Roy, 1999, p31). 

             o  This applies to the individual (a bio-psycho-social being), to people within groups  and/or society in general. Coping mechanisms employed may either be     innate     or  acquired based on previous experiences.

·        Environment – stimuli that impact behavior and ability to adapt.             

    o These may be viewed as inputs into the adaptive model that affect transformation. Stimuli may be focal (internal or external immediately encountered); contextual (includes all stimuli influencing behavior toward focal); or residual (effects may not be easily observable or known). 

·        Nursing – utilizes the four modes of adaptation to promote health and integration for  clients             

         o  This applies to the nursing process and nurses ability to influence positive adaptive  responses to contribute to health 

·        Health – outcome or output of adaptation             

            o  This includes the continuum of health
APPLICATION TO PRACTICE

 Roy’s Adaptation Model has been used extensively as the conceptual framework for
nursing curriculum and translates for use in practical nursing settings promoting direct purpose. The RAM may also be applied to the nursing practice utilizing the nursing process to assess behaviors affected by stimuli and develop interventions that promote positive adaptation. 
Examples Using RAM

Barone, S. H. (2012). Coping and adaptation in adults living with spinal cord injury. Journal of Neuroscience Nursing, 44(5), 271-283.

Barone, S., Roy, C., Frederickson, K. (2008). Instruments used in roy adaptation model-based research: Critique, examples and future Directions. Nursing Science Quarterly, 21(4), 353-363.

Weiland, S. (2010). Integrating spirituality into critical care: An APN perspective using Roy’s adaptation model. Critical Care Nursing Quarterly, July-Sep: 33(3), 282- 291.



RELEVANCE TO PERSONAL PRACTICE

 Review of Roy’s perspective on the continuum of health wherein responses to environmental stimuli shapes the integration of health and self-awareness, broadened my appreciation for utilizing this as a guide to structure initiatives for patient safety.  I will be participating in a trial of a new model proposed for nursing education and professional development specifically around discharge education. The model, developed by a colleague to trial  in both a pediatric and adult ICU setting, will examine the efficacy of a new model for increasing patient education while striving for increased staff engagement, autonomy and accountability within the framework of shared governance. As a new Professional Development Manager, it is this spirit of collaboration, investigation and application that is shaped by the theory utilized. The theory or model will provide the framework by which professionalism will be fostered and enhanced with the ultimate goal of improved patient outcomes and quality measures.

The research to test the efficacy of a newly developed model for promoting professional development adherers to Roy's stance that evaluating theories is an obligation for nursing and should take precedence. Superimposing Roy's adaptation model to the research will assist in guiding implementation. Additionally, the conceptual framework will provide the structure to evaluate the nurses' ability to adapt to the changing environment created with expectations for increased engagement and ownership of outcomes as well as the nurses' ability to adopt and adapt a new model to impact practice and increase efficiency. This highlights the interdependence and role function mode of adaptability and clearly defines goals for nurses for increased  autonomy.

References

The Cognator and the Regulator. [Online images]. 
Retrieved from http://nursingtheories.weebly.com/sister-callista-roy.html

Kenney, J. (2013). Theory-based advanced practice nursing. In S. Denisco & A. Barker (Eds.), Advanced Practice Nursing: Evolving roles for the transformation of the professional (pp. 361-377). Burlington, MA: Jones & Bartlett. 

McEwen, M., & Wills, E. M. (2011). Theoretical basis for nursing. (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Roy, C.(2009). The Roy adaptation model (3rded.) Upper Saddle River, NJ: Pearson.

Roy Adaptation Model. [Online image]. Retrieved from
http://images.search.yahoo.com/r/_ylt=A0PDoS65S0dRMEsA6yCjzbkF;_
ylu=X3oDMTBtdXBkbHJyBHNlYwNmcC1hdHRyaWIEc2xrA3J1cmw-/SIG=12av24png/EXP=1363655737/**http%3a//nnsnchez.girlshopes.com/callistaroysadaptation/


Sister Callista Roy. [Online image]. Retrieved from
http://nursingtheories.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html

Tourville, C. and Ingalls, K. (2003). The living tree of nursing theories. Retrieved from SHU eReserves-NU433.

 


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