12. ROY'S THEORY.ppt

Sister Callista Roy’s
Adaptation Model
Presented By:
Mrs. Jagjit Kaur

 It is the framework for nursing
practice and the direction for
nursing research.
 Sister callista Roy’s adaptation
theory (Roy and Obloy
1979,Roy 1980,1984,1989)
views the client as an adaptive
system.
INTRODUCTION

BIOGRAPHICAL SKETCH OF THE NURSE
THEORIST
 Sister callista Roy was born on
oct, 14,1939.
 She did her bachelors of arts in
nursing from mount st. Mary’s
college, losAngeles in 1963
and masters of science in
nursing from ,University of
California,Los Angeles1966.

CONTD….
 She also received her masters of arts(M.A) in
sociology from the same university in 1975 and Ph.D
in sociology .
 Roy was an associate professor and chairperson of
the department of nursing at mount Saint Mary’s
college until 1982.

CONTD….
 From 1983 to 1985; she was Post Doctoral fellow at
Robert Wood Johnson at University of California, as a
clinical nurse scholar in neuroscience.
 In 1988 Roy began the newly created position of
graduate faculty at, Boston school of nursing.

CONTD….
 According to Roy’s model, the goal of nursing is to
help the person’s adaptive system.
 According to Roy’s model, the goal of nursing is to
help the person adapt to change in physiological
needs, self-concepts, role function and
interdependent relations during health and illness
.

CONTD….
All individual must adapt to the
following demands:
1. Meeting basic physiological
needs.
2. Developing a positive self-
concept.
3. Performing social roles.
4. Achieving a balance between
dependence and
interdependence.

CONTD….
It is role of nurse:
 To find out demands which
are causing problems for a
client.
 To assess how well the client
is adapting to them. Nursing
care is then directed at
helping the client to adopt.

ORIGIN OF THE MODEL:
 While a student of M.sc. nursing, at the university of
California sister C. Roy was challenged in a seminar
by another nurse theorist Dorothy E.JOHNSON to
develop a theory of nursing , subsequently in 1970
the ‘ROY ADAPTATION MODEL’ was born as a
derivation of Bertalanfty (1968) general system theory
and Harry Helson’s Adaptation level theory (1964).

CONTD….
1. The person is a bio-psycho-social
being includes biologic components
(Anatomy and Physiology),
psychological and social
components.
2.The person is in constant interaction
with a changing environment
(interaction with physical, social &
psychological environment changes)

CONTD…
3.To cope with a changing world, the
person uses both innate and
acquired mechanisms which are
biologic,psychological and social in
origin.
4.Health and illness are an
inevitable dimension of the
person’s life.
5.To respond positively to
environmental changes, the person
must adapt (changing environment
demands positive response)

CONTD….
6.The person’s adaptation is a function
of the stimulus, he is exposed to and
his adaptation level, which is
determined by the combined effect of
three classes of stimuli:
*focal stimuli
*contextual stimuli
*Residual stimuli

CONTD….
*Focal stimuli or stimuli demanding prompt attention.
*Contextual stimuli or stimuli present in a
surrounding and situation.
*Residual stimuli such as belief, attitude and habits,
which have an indeterminate on the present situation.

CONTD….
8. The person is conceptualized as
having four modes of adaptation:
 psychological needs
 self-concept,
 role function, and
 interdependence relations.

The four principles are
:
 The individual is viewed
in the context of the
purposefulness of human
existence.
 Unity of purpose of
human kind
 Activity & creativity for
the common goods
 Value of meaning of life.

CONCEPTS OF MODEL
 Roy’s model is a system model that focuses on
outcomes. the major features of the system models
are the:
-System and its environment
 A system is a set of parts connects to function as a
whole for some purposes and are interdependence of
its parts.

CONTD….
 Keys elements in the Roy
adaptation model are-
1. The person who is recipient of
nursing care
2. The goal of nursing.
3. The concept of health
4. The direction of nursing
activities.

CONTD…
 Person: Roy uses person in her model as a concept
to identify the recipient of nursing care. critical to the
model is the description of recipient of nsg care as
holistic adaptive systems.
 Persons as living systems are in constant interactions
with their environments between the system and the
environment occurs on exchange of information,
matter and energy.

Goal-the goal of nsg. as the
promotion of adaptive responses
in relation to the four adaptive
modes (physiological, self
concept, role function and
interdependence)and contribute to
health.

 Nsg activities-The nursing activities are
delineated by the model as those that
promotes adaptive responses in situation
of health and illness. The nsg activities are
identified as actions taken by nurses to
manipulate the focal, contextual residual
stimuli impringing on person.

CONTD….
 The nsg process acc. to Roy’s
model consists of six steps-
(1)Acceptance of behavior
(2)Acceptance of stimuli
(3)Nsg diagnosis
(4)Goal setting
(5)Intervention
(6)Evaluation

Health-health has been defined as a “state and
process of being and becoming an integrate and
whole person’’ Health is a process where by
individuals are striving to achieve their maximum
potentials.

Environment-stimuli from within the person and
stimuli from around the person represents the
element of environment acc. to Roy.
 Environment is specifically defined by Roy as “all
conditions, circumstances influences surrounding
and affecting the development and behavior of
persons and groups.

6. THE PERSON AS AN ADAPTIVE
SYSTEM
In addition to the concept of person,goal of
nsg,health and environment and nsg activities in
the model ,the theory of person as an adaptive
system employs additional concepts.

The person as an adaptive system

CONTD…
 Contextual stimuli-observable, measureable and
reported by the person.
 Residual stimuli-those make up characteristics of
the person that are present and relevant to
situation.

CONTD…….
Example: Mr. smith experiencing the chest
pain, the stimulus immediately confronting Mr.
smith,the focal stimulus ,is the deficit of
oxygen supply to his heart muscles.The
contextual stimuli include the 90 degree of
temperature ,the sensation of pain ,Mr. smith’s
age ,weight,blood sugar level,and degree of
coronary artery patency.The residual stimuli
include his history of cigarette smoking and
work relate stress.

CONTD….
 Mechanisms are of 2 types:
(1)Regulator is used primarily as a mechanism to
cope with physiological stimuli.
(2)Cognator used mainly as mechanism to cope
with psychological stimuli dealing primarily in area
of cognition, judgment and emotion.
-Regulator and cognator mechanisms are linked
through the process of perception.

CONTD….
Effectors: Roy has identified four adaptive modes;
 Physiological
 self concept
 role function
 interdependence.

7. THEORY OF ADAPTIVE MODES:
The theory of adaptive modes was developed in 1981,
consist of four parts:
 physiological,
 self concept,
 role function &
 interdependence.

CONTD…
Each adaptive mode represents a grouping of
behaviors that promote the individuals movements
towards the general goals (survival, growth,
reproduction, mastery).

CONTD…..
(1)PHYSIOLOGICAL MODE
Physiological wholeness is achieved
by adapting to changes in
physiological needs.
 The regulator coping mechanism is
primarily responsible for attaining and
maintaining this integrity.
 other complex process that
influences regulator
activities are the senses, fluids and
electrolytes, neurological function &
endocrine function.

Five primary needs have been identified as
necessary for physiological integrity:
 oxygen,
 nutrition,
 activity rest,
 protection,
 elimination

CONTD…
(2)SELF CONCEPT MODE
Self concept is one of the 3 psychosocial modes, the
basic human need within modes in psychic
integrity,which means people need to know who they
are so that can exist with a sense of unity.

CONTD…..
 Physical self: is an appraisal of one’s physical,
attributes, appearance, functioning,
sensation(feeling about self) sexually and
wellness illness status.
 Personal self: is an appraisal of one’s own
characteristics, expectations, values & worth.
Personal self has been divided into the moral
ethical spiritual self ,self consistency & self ideal,
self expectancy e.g. I believe God will help me
through this surgery.

CONTD…..
(3)ROLE FUNCTION MODE:
The basic need in the role function adaptive model is
for social integrity. This means that people need to
know who they are in relation to others so that they
can act. All people have role in society. With each role
there are expected behavior .Role have been divided
into primary, secondary and tertiary.

CONTD….
(4)INTERDEPENDENCE MODE
Interdependence is a social adaptive
mode,needs affection adequacy or the feeling of
security in nurturing relationships.
 Interdependence means the close relationship of
people that involves willingness & ability to love,
respect & value others and to accept & responds
to love, respect and value given by others.
 Loneliness as a common adaptation problem
resulting from a disruption in the modes.

Those currently identified
needs are listed below:
(a) Basic physiological needs-
 Exercise and rest
 Nutrition
 Elimination
 Fluid and electrolyte
 Oxygen
 Circulations
 Regulations

CONTD….
(b)self concepts:
 Physical self
 Personal self
 Interpersonal self
(c) role mastery:
-Role failure
-Role conflict

CONTD….
 Nature of planning and goal setting process
 The focus of nsg interventions during the
implementation of the nsg care plan
 The nature of the process of evaluating the quality of
effects of the care given.

NURSING PROCESS ACCORDING TO RAM
A problem solving approach for gathering data,
identifying the capacities and needs of the human
adaptive system, selecting and implementing
approaches for nursing care, and evaluation the
outcome of care provided.
o Assessment of Behavior: the first step of the nursing
process which involves gathering data about the
behavior of the person as an adaptive system in each of
the adaptive modes.

CONTD….
 Assessment of Stimuli: the second step of the
nursing process which involves the identification of
internal and external stimuli that are influencing the
person’s adaptive behaviors.
Stimuli are classified as:
1) Focal- those most immediately confronting the
person
2) Contextual-all other stimuli present that are
affecting the situation
3) Residual- those stimuli whose effect on the
situation are unclear.

 Nursing Diagnosis: step three of the nursing process
which involves the formulation of statements that
interpret data about the adaptation status of the person,
including the behavior and most relevant stimuli

GOAL SETTING
 the fourth step of the nursing process which
involves the establishment of clear statements of
the behavioral outcomes for nursing care.

 Intervention: the fifth
step of the nursing
process which involves
the determination of
how best to assist the
person in attaining the
established goals

 Evaluation: the sixth
and final step of the
nursing process which
involves judging the
effectiveness of the
nursing intervention in
relation to the behavior
after the nursing
intervention in
comparison with the
goal established.

DEMOGRAPHIC DATA


Name
Mr. NR
Age 53years
Sex Male
IP number ------
Education Degree
Occupation Bank clerk
Marital status Married
Religion Hindu
Informants Patient and Wife
Date of admission 21/01/08

FIRST LEVEL ASSESSMENT
PHYSIOLOGIC-PHYSICAL MODE
Oxygenation:
 Stable process of ventilation and stable process of gas exchange.
RR= 18Bpm.
 Chest normal in shape. Chest expansion normal on either side.
 Apex beat felt on left 5th inter-costal space mid-clavicular line.
 Air entry equal bilaterally. No ronchi or crepitus.
 No abnormal heart sounds.
 S1& S2 heard.
 BP- Normotensive. .

CONTD….
Nutrition
 He is on diabetic diet (1500kcal). Non
vegetarian.
 Recently his Weight reduced markedly (10
kg/ 6 month).
 He has stable digestive process.
 He has complaints of anorexia and not
taking adequate food.
 No abdominal distension. No tenderness.
 Bowel sounds heard.
 Percussion revealed dullness over
hepatic area.

CONTD….
Elimination:
 No signs of infections, no
pain during micturation or
defecation.
 Normal bladder pattern.
Using urinal for micturation.
 Stool is hard and he
complaints of constipation.

CONTD….
o Now, activity reduced due to
amputated wound. Mobility impaired.
 Walking with crutches.
 Pain from joints present. No
paralysis.
 ROM is limited in the left leg due to
wound.
 No contractures present. No swelling
over the joints.
 Patient need assistance for doing the
activities.

CONTD….
Protection:
 Left lower fore foot is amputated.
 Black discoloration present over the area.
 No redness, discharge or other signs of infection.
 Wound healing better now.
 Pain form knee and hip joint present while walking.
 Dorsalis pedis pulsation, not present over the left leg. Right
leg is normal in length and size.
 All peripheral pulses are present with normal rate, rhythm and
depth over right leg.

CONTD….
Senses:
 No pain sensation from the wound site. Relatively,
reduced touch and pain sensation in the lower
periphery; because of neuropathy. Using spectacle
for reading. Gustatory, olfaction, and auditory
senses are normal.
Fluids and electrolytes:
 Drinks approximately 2000ml of water. Stable
intake out put ratio. Serum electrolyte values are
with in normal limit. No signs of acidosis or
alkalosis. Blood glucose elevated.

CONTD….
Neurological function:
 He is conscious and oriented.
 He is anxious about the disease
conditon
 Touch and pain sensation
decreased in lower extrimity.
Endocrine function
 He is on insulin. No signs and
symptoms of endocrine
disorders, except elevated blood
sugar value. No enlarged glands.

CONTD….
Personal self:
 Self esteem disturbed because of financial burden and
hospitalization. He believes in god and worshiping Hindu
culture.
ROLE PERFORMANCE MODE:
 He was the earning member in the family. His role shift
is not compensated. His son doesn’t have any work. His
role clarity is not achieved. INTERDEPENDENCE
MODE:
 He has good relationship with the neighbours. Good
interaction with the friends relatives. But he believes, no
one is capable of helping him at this moment. He
says ”all are under financial constrains”. He was
moderately active in local social activities

SECOND LEVEL ASSESSMENT
FOCAL STIMULUS:
 Non-healing wound after amputation of great and
second toe of left leg- 4 week. A wound first found
on the junction between first and second toe-4
month back. The wound was non-healing and
gradually increased in size with pus collected over
the area.
 He first showed in a local hospital,referred to
medical college; During hospital stay great and
second toe amputated. But surgical wound turned to
non- healing with pus and black colour. So the
physician suggested for below knee amputation.
That made them to come to ---Hospital, ---. He
underwent a plastic surgery 3 week before.

CONTD….
CONTEXTUAL STIMULI:
 Known case DM for past 10 years. Was on oral
hypoglycemic agent for initial 2 years, but switched
to insulin and using it for 8 years now. Not wearing
foot wear in house and premises.
RESIDUAL STIMULI:
 He had TB attack 10 year back, and took complete
course of treatment. Previously, he admitted in ---
Hospital for leg pain about 4 year back. . Mother’s
brother had DM. Mother had history of PTB. He is a
graduate in humanities, no special knowledge on
health matters.

ASSESS. OF
BEHAVIOUR
ASSESSMENT
OF STIMULI
NURSING
DIAGNOSIS
GOAL INTERVEN
TION
EVALUA
TION
Impaired
activity
in physical-
physiological
mode
Focal stimuli:
During hospital
stay great and
second toe
amputated. But
surgical wound
turned to non-
healing with
pus and black
colour.
2. Impaired
physical
mobility related
to amputation
of the left
forefoot and
presence of
unhealed
wound
Long term
Objective:
Patient will
attain
maximum
possible
physical
mobility with in
6 months.
- Assess the
level of restriction
of movement
- Provide active
and passive
exercises to all
the extremities to
improve the
muscle tone and
strength.
- Make the
patient to perform
the ROM
exercises to lower
extremities which
will strengthen
the muscle.
-
Short term
goal:
Met: used
crutches
correctly on
22/4/08.
he is self
motivated in
doing minor
excesses
Partially Met:
walking with
minimum
support.

CONCLUSION
 Mr.NR who was suffering with diabetes
mellitus for past 10 years. Diabetic foot
ulcer and recent amputation made his life
more stressful. Nursing care of this patient
based on Roy's adaptation model provided
had a dramatic change in his condition. He
studied how to use crutches and mobilized
at least twice in a day. Patient’s anxiety
reduced to a great extends by proper
explanation and reassurance. He gained
good knowledge on various aspect of
diabetic foot ulcer for the future self care
activities.

Scope
 Grand theory RAM
 Middle range theory evolved RAM:-
 Caregivers’s effectiveness & well being.
 Coping with pain & chronicity.
 Coping with diabetes.
 Gentle touch in preterm infants.

CONTD…
Significance
 1987 – over 100,000 nurses have
graduated from program based on
RAM
 Used by global scholars
 Models used in research , curriculum
development, social issues , chronic
illness & development of research
instruments.

Utility
 Research tool development
 Describes responses to health illness.
 Evaluates intervention
 Measures perception of adaptation levels.
 Measures perception of powerlessness & decision
making.
 Measures health care outcomes of cancer patients.
 Regaining functional abilities after delivery.
 Used to identify adaptive and maladaptive behavior
to stimuli.
 Lack of motivation to quit smoking.
 Assessing & planning care of surgical patients.
 Care of geriatric patients.

CONTD….
 Obstetrical, peadiatric and neonatal settings.
 Cardiac patients.
 Elder care
 Pshychiatric setting & organic brain syndrome.

9. APPLICATION OF R.A.M IN NURSING
(1) Nsg practice- R.A.M is a very useful method in nursing
practice specially in those setting where there are
convert psychological needs which are as essential as
physical one. Roy’s models are very effective in
pediatrics as well as community and rehabilatory nsg.

CONTD….
(2)Nursing Research-
R.A.M provide a conceptual model for
nursing process and this has been a
basis for number of research being
done.for e.g measuring functional
status after child birth,functional status
during pregnancy.
If research is to affect practitioners’
behavior, it must be directed at testing
and retesting conceptual models for
nursing practice. Roy has stated that
theory development and the testing of
developed theories are nursing’s
highest priorities. The model must be
able to regenerate testable hypotheses
for it to be researchable.

CONTD….
(3)Education-
RAM useful in educational setting. Roy states that the model defines for
students the distinct purpose of nursing which is to promote man’s
adaptation in each of the adaptive modes in situations of health and
illness.

12. ROY'S THEORY.ppt

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12. ROY'S THEORY.ppt