Sister Callista Roy: Adaptation Model of Nursing

Roy watched sick children bounce back from physical and psychological blows that should have flattened them, and she built a whole model around that one observation: people adapt, and nursing's job is to help them do it. This guide covers her biography and the Adaptation Model of Nursing.

Biography of Callista Roy

Sister Callista L. Roy (born October 14, 1939) is a nursing theorist, professor, and author, known for creating the Adaptation Model of Nursing.

Education and Career

Roy earned a Bachelor of Arts with a major in nursing from Mount Saint Mary's College in Los Angeles in 1963 and a master's degree in nursing from the University of California in 1966. She then moved into sociology, earning a master's in sociology in 1973 and a doctorate in sociology in 1977, both from California.

During her master's work she was challenged in a seminar with Dorothy E. Johnson to develop a conceptual model for nursing. Working as a pediatric nurse, Roy was struck by children's resilience and their ability to adapt to major physical and psychological change, and she set out to build a conceptual framework around it. She developed the model's basic concepts as a graduate student at the University of California from 1964 to 1966, then began operationalizing it in 1968 when Mount Saint Mary's College adopted the adaptation framework as the philosophical foundation of its nursing curriculum.

Roy was associate professor and chairperson of the Department of Nursing at Mount Saint Mary's College until 1982 and was promoted to professor in 1983 at both Mount Saint Mary's College and the University of Portland, where she helped start and taught in a summer master's program. She was a Robert Wood Johnson postdoctoral fellow at the University of California, San Francisco, from 1983 to 1985 as a clinical nurse scholar in neuroscience, researching nursing interventions for cognitive recovery in head injuries and the influence of nursing models on clinical decision making.

From 1987 to the present she has held the resident nurse theorist position created at Boston College School of Nursing, teaching doctoral, master's, and undergraduate students. In 1991 she founded the Boston Based Adaptation Research in Nursing Society (BBARNS), later renamed the Roy Adaptation Association. Her other work includes conceptualizing and measuring coping and developing the philosophical basis for the adaptation model and nursing's epistemology. Roy belongs to the Sisters of St. Joseph of Carondelet.

Works

Roy has published widely on nursing theory and other professional topics, and her work has been translated into many languages. With colleagues at the Roy Adaptation Association she critiqued and synthesized the first 350 research projects published in English based on her adaptation model. Her best-known work is the Roy adaptation model of nursing.

Published works

1. Roy, S. C. (2014). Generating middle-range theory: From evidence to practice. New York, NY: Springer.
2. Roy, S. C., & Harrington, A. (2013). Roy adaptation model-based research: Global view. Generating Middle range theory: From evidence to practice (pp. 355-365). New York, NY: Springer.
3. Roy, S. C. (2013). From US nurse theorist's view of person and good of society: Dr. Callista Roy (p. 3), in Cristina Monforte, RN, MSN, PhD (Ed.), Catalunya: Universitat Internacional de Catalunya (UIC).
4. Roy, S. C., Barone, S. H. (2013). Pedagogic materials for generating middle range theories: Evidence for practice. In S.C Roy (ed.). Generating Middle Range Theory: From Evidence to Practice. New York, NY: Springer.
5. Roy, S. C. (2011). Research-based on the Roy adaptation model: Last 25 years. Nursing Science Quarterly, 24(4), 312-320.
6. Roy, S. C. (2011). Extending the Roy Adaptation Model to Meet Changing Global Needs. Nursing Science Quarterly, 24(4), 345-351.
7. Senesac, P. M., Roy, S. C. (2010). Sister Callista Roy's Adaptation Model, In M. Parker and M. Smith (Ed.), Nursing Theories and Nursing Practice (ed., pp. 40 page manuscript). Philadelphia, PA: F.A. Davis.
8. Jones, D. A., Roy, S. C., K. A. (2013). Marjory Gordon Living Legend. NANDA- International Journal of Nursing Terminologies and Classification, 21(2), 2.
9. McCurry, M.S., Hunter Revell, S., & Roy, C. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42-52.
10. Roy, C. (2009). The Roy Adaptation Model, 3rd edition. Upper Saddle River, NJ: Prentice-Hall Health.
11. Barone, S., Roy, C., & Frederickson, K. (2008). Instruments used in Roy Adaptation Model-based research: Review, critique, and further directions. Nursing Science Quarterly. 21(4), 353-362.
12. Roy, C. (2007). Update from the future: Thinking of Theorist Callista Roy. Nursing Science Quarterly, 20(2), 113-116.
13. Roy, Sr. C. & Jones, D. (Editors). (2007). Nursing knowledge development and clinical practice. New York, NY: Springer.
14. Jones, D.A., Roy, C.A., & Avant, K. (2010). Marjory Gordon, living legend. NADA- International Journal of Nursing Terminologies and Classifications, 21(2), 80-81.
15. Roy, C. (2010). Assessment and the Roy Adaptation Model. (M. Ito, Trans.). Journal of Japan Society of Nursing Diagnosis, 15(1), 35-41.
16. Roy, S.C., & Dowlatshahi, M. (2010). Forward. In Nursing Concepts and Nursing Theories Glossary (pp. 2-3). Tehran, Iran: Medical Sciences Publishing Center.
17. Roy, S. C., Zhan, L. (2010). Sister Callista Roy's Nursing Adaptation Model and its Applications. In M. Parker & M. Smith (Eds.), Nursing Theories and Nursing Practice, 3rd edition, (pp. 167-181). Philadelphia, PA: F.A. Davis.
18. Roy, C. (2010). Nursing practice and research based on the Roy Adaptation Model. Bulletin of St. Mary's College, 5-13.
19. Roy, C. (2010). Thoughts from a theorist. Roy Adaptation Review, 13(1), 5.
20. Roy, C.(2009). Forward. In J. Cutliffe, K. Hyrkas, & H.P. Mckenna (Eds.), Nursing Models: Application to Practice. London. UK: Quay Books.
21. Roy, C., & Solodiuk, J. (2009). Global nursing conference focused on knowledge for good of persons and society with reflections from Ph.D. students. International Network for Doctoral Education in Nursing (INDEN) Newsletter, 8(1), 5-6.
22. Roy, C., Whetsell, M.V., & Frederickson, K. (2009). The Roy Adaptation Model and research: Global perspective. Nursing Science Quarterly, 22(3), 209-211.
23. Roy, C. (2009). Thoughts from a theorist. Nursing Science Quarterly, 12(1), 4.
24. Roy, C. (2009). Assessment and the Roy Adaptation Model. The Japanese Nursing Journal, 29(11), 5-7.
25. Roy, C. (2008). Adversity and theory: The broad picture. Nursing Science Quarterly. 21(2), 138-139.
26. O'Connor, A. & Roy, C. (2008). Electric power plant emissions and public health. American Journal of Nursing. 108(2), 62-70.
27. Magee, T. & Roy, C. (2008). Predicting school-age behavior problems: The role of early childhood risk factors. Pediatric Nursing, 34(1), 37-43.
28. Willis, D., Grace, P., & Roy, C. (2008). A central unifying focus for the discipline: Facilitating humanization, meaning, choice, quality of life, and dying. Advances in Nursing Science. (31)1. online only: www.advancesinnursingscience.com
29. Chayput, P. & Roy, C. (2007). Psychometric testing of the Thai version of coping and adaption processing scale, short form (TCAPS-SF). Thai Journal of Nursing Council, 22(3), 29-39.
30. Roy, C. (2007). Update from the future: Thinking of Theorist Callista Roy. Nursing Science Quarterly, 20(2), 113-116.
31. Roy, C. (2007). The Roy Adaptation Model: Historical and Philosoph-ical Foundations. In Maria Elisa Moreno, et al. (Eds.) Applicacion Del Model Adaptacion en el Ciclo Vital Humano, 2nd Edition. Chia, Columbia: Universidad de La Sabana.
32. Roy, C. (2007). Fundamental History and Philosophy of the Roy Adaptation Model. In Guitierrez, M. dC (Ed.) Adaptacion y Cuidado en el ser Humano: Una Vision de Enfermeria. Bogota: Editorial El Manual Moderno, Universidad de la Sabana, 1-12.
33. Roy, C. & Lindendoll, N. (2006). Defining international consensus on mentorship in doctoral education. Journal of Research in Nursing, 11(4), 345-353.
34. Morgillo-Freeman, S. & Roy, C. (2005). Cognitive behavior therapy and the Roy Adaptation Model: A discussion of theoretical integration. In S.M. Freeman & A. Freeman (Eds.), Cognitive Behavior Therapy in Nursing Practice. New York: Springer Publishing Company, 3-27.
35. Roy, C. & Gray, M. (2005). Role of the supervisor/mentor. In Ketefian, S. & McKenna, H.P. (Eds.). Doctoral Education in Nursing International Perspectives. New York: Routledge.
36. Roy, C. (2003). Reflections on Nursing Research and the Roy Adaptation Model. Igaju-syoin Japanese Journal, 36(1), 7-11.
37. Whittemore, R. & Roy, C. (2002). Adapting to Diabetes Mellitus: A Theory Synthesis. Nursing Science Quarterly, 15(4), 311-317.

Awards and Honors

In 2007 Roy was named a Living Legend by the American Academy of Nursing and the Massachusetts Registered Nurses Association. She is a Sigma Theta Tau member and received the National Founder's Award for Excellence in Fostering Professional Nursing Standards in 1981. Her honors include an Honorary Doctorate of Humane Letters from Alverno College in 1984, honorary doctorates from Eastern Michigan University (1985) and St. Joseph's College in Maine (1999), and the American Journal of Nursing Book of the Year Award for The Roy Adaptation Model Essentials.

More of her awards and honors:

• 2013 – Distinguished Graduate Award, Bishop Conaty/Our Lady of Loretto High School
• 2013 – Honorary Doctoral Degree, Holy Family University
• 2013 – Alumni Award for Professional Achievement, UCLA
• 2013 – Excellence in Nursing, The University of Antioquia, Medellin Colombia
• 2011 – Nursing Science Quarterly Special Issue Honoring the work of Callista Roy, Vol. 24, Num. 4, Oct. 2011
• 2011 – Faculty Senior Scientist Poster Exemplar Award, Yvonne L. Munn Center for Nursing Research and the Nursing Research Expo Committee, Massachusetts General Hospital
• 2011 – The Sigma Mentor Award, Sigma Theta Tau International Alpha Chi Chapter
• 2010 – University of Southern Alabama Picture Gallery of Theorist, University of Alabama
• 2010 – Inducted to Nurse Researcher Hall of Fame, Inaugural Class, Sigma Theta Tau International, Honor Society of Nursing
• 2010 – "Sixty Who have Made a Difference," UCLA School of Nursing, 6th Anniversary
• 2010 – Inductee, Sigma Theta Tau International Nurse Researcher Hall of Fame
• 2007 – American Academy of Nursing Living Legend Award

Callista Roy's Adaptation Model of Nursing

The Adaptation Model of Nursing sees the individual as a set of interrelated systems holding a balance among various stimuli. Roy first presented it in a 1970 Nursing Outlook article, "Adaptation: A Conceptual Framework for Nursing," and that same year Mount St. Mary's School in Los Angeles, California, adopted it. The model was conceived when Dorothy Johnson challenged her seminar students to build conceptual models of nursing; Johnson's own model was the impetus. Roy drew on Harry Helson's Adaptation-Level Theory of Perception, Ludwig von Bertalanffy's System Model, and Anatol Rapoport's system definition.

Start with the system as applied to an individual. Roy views the person holistically: separate parts act together as one unified being. As living systems, persons are in constant interaction with their environment, exchanging information, matter, and energy. A system has inputs, outputs, controls, and feedback.

Assumptions

Scientific Assumptions

• Systems of matter and energy progress to higher levels of complex self-organization.
• Consciousness and meaning are constructive 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 created in human consciousness.
• Integration of human and environmental meanings results in adaptation.

Philosophical Assumptions

• Persons have mutual relationships with the world and God.
• Human meaning is rooted in the 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.

Major Concepts of the Adaptation Model

The model's major concepts, including the nursing metaparadigm as the theory defines it:

Person

"Human systems have thinking and feeling capacities, rooted in consciousness and meaning, by which they adjust effectively to changes in the environment and, in turn, affect the environment."

Humans are holistic beings in constant interaction with their environment. They use a system of adaptation, both innate and acquired, to respond to environmental stimuli. Human systems can be individuals or groups, such as families, organizations, and the whole global community.

Environment

"The conditions, circumstances and influences surrounding and affecting the development and behavior of persons or groups, with particular consideration of the mutuality of person and health resources that includes focal, contextual and residual stimuli."

The environment is the stimulus, or input, that requires a person to adapt, and the stimuli can be positive or negative. Roy categorizes them as focal, contextual, and residual. Focal stimuli confront the human system and require the most attention. Contextual stimuli are the rest of the stimuli present with the focal stimulus that contribute to its effect. Residual stimuli are additional environmental factors whose effect is unclear, including previous experience with certain stimuli.

Health

"Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to cope with them in a competent way."

Health is the state in which humans can continually adapt to stimuli. Because illness is part of life, health and illness can coexist. Continuing to adapt holistically maintains health toward completeness and unity; failing to adapt negatively affects the person's integrity.

Nursing

"[The goal of nursing is] the promotion of adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health, quality of life, and dying with dignity."

Nurses are facilitators of adaptation. They assess the patient's behaviors, promote positive adaptation by improving environmental interaction and helping the patient respond positively to stimuli, and remove ineffective coping mechanisms to drive better outcomes.

Adaptation

Adaptation is the "process and outcome whereby thinking and feeling persons as individuals or in groups use conscious awareness and choice to create human and environmental integration."

Internal Processes

Regulator

The regulator subsystem is the person's physiological coping mechanism. The body adapts by regulating bodily processes, including the neurochemical and endocrine systems.

Cognator

The cognator subsystem is the person's mental coping mechanism. The person uses the brain to cope through the self-concept, interdependence, and role function adaptive modes.

Four Adaptive Modes

The four adaptive modes are how the regulator and cognator mechanisms show up externally.

Physiological-Physical Mode

The physical and chemical processes in the function and activity of living organisms, set in motion by the regulator subsystem. Its basic needs cover oxygenation, nutrition, elimination, activity and rest, and protection. Its complex processes cover the senses, fluid and electrolytes, neurologic function, and endocrine function.

Self-Concept Group Identity Mode

The goal is a sense of unity, purposefulness in the universe, and identity integrity, including body image and self-ideals.

Role Function Mode

Focuses on the primary, secondary, and tertiary roles a person occupies and knowing where they stand as a member of society.

Interdependence Mode

Focuses on relational integrity through giving and receiving love, respect, and value, achieved through effective communication and relationships.

Levels of Adaptation

Integrated Process

The modes and subsystems meet environmental needs through stable processes (breathing, spiritual realization, a successful relationship).

Compensatory Process

The cognator and regulator are challenged but still working to meet the need (grief, starting a new job, compensatory breathing).

Compromised Process

The modes and subsystems are not adequately meeting the challenge (hypoxia, unresolved loss, abusive relationships).

Six-Step Nursing Process

The nurse manipulates stimuli, removing, decreasing, increasing, or altering them so the patient can adapt:

1. Assess the behaviors shown across the four adaptive modes.
2. Assess the stimuli and categorize them as focal, contextual, or residual.
3. State a nursing diagnosis of the person's adaptive state.
4. Set a goal to promote adaptation.
5. Implement interventions aimed at managing the stimuli.
6. Evaluate whether the adaptive goal has been met.

Analysis

The model is time-consuming to apply. In emergencies that demand quick action it is hard to complete, and the patient may move through the whole adaptation process before a full assessment can support thorough interventions. Adaptive responses vary by individual and can take longer in some, so the nurse's span of control may run out by discharge.

Unlike Levine, who addressed adaptation as one piece, Roy focused on the whole adaptive system, linking each concept to the individual's coping mechanisms during adaptation. When a patient shows an ineffective response, the nurse's role is not clearly spelled out. The model is built to promote adaptation but says little about preventing and resolving maladaptation.

Strengths of Roy's Adaptation Model

• It accounts for multiple causes in a situation, a strength when dealing with multifaceted human beings.
• The concepts follow logically, each carrying the recurring idea of adaptation to maintain integrity, and each is operationally defined.
• The concepts are stated in relatively simple terms.
• It guides nurses to use observation and interviewing for an individualized assessment, and the concepts apply across many practice settings.

Weaknesses

• Careful application demands significant time and effort.
• The model carries many elements, systems, structures, and concepts.