Roy's Adaptation Model in Nursing

Effective nursing practice is built upon a solid foundation of knowledge, skills and compassion as well as maintaining the ability to care for patients and their families in an efficient, effective and helpful way. Nursing care is rooted in research and theories that are applied into practice in order to provide the best patient care possible (Saleh, 2018). This paper will explore the Roy’s Adaption Model and describe how the theory has evolved by using the theorists’ voice. This paper will describe the four stages of the evolution of the theory which include theorizing, syntax, theory testing and evaluation. I have chosen this theory as it is the foundation of the nursing process and utilized in every aspect of nursing practice. It also resonates with me as I believe that people’s behaviors are influenced by their environment and that they can achieve optimal health if they are able to adapt successfully to challenges.

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The first step is theorizing, which includes understanding how the theory was developed. I, Sister Callista Roy, created the Roy’s Adaption Model in 1964 when my professor, Dorothy E. Johnson, challenged me to define the goal of nursing. My theory was created because I believe that nurses have the ability to help patients deal with difficulties in the environment by adapting to change and to move effectively towards health. My family, religion, mentors, clinical experiences and education all had an influence on the development of the model. While I was at my pediatric clinical rotations, I would observe and gather data from the patients and families for my research. I started thinking like a researcher even as a student (Roy, 2011). Within the model, the key concepts comprise of the person, health, environment and nursing. Nursing is the practice and science that increases adaptive abilities and supports person and environment conversion. The goal of nursing is to encourage adaption within the four adaptive modes for individual patients or in groups or populations. The four adaptive modes include the physiologic needs, self-concept, role function, and interdependence. The nurse assesses the behavior and aspects that impact adaptive abilities and intervenes to assist with the development of those abilities in order to improve environmental interactions. Adaption helps the person to find purpose and meaning in life and increase their holistic well-being. The outcomes of adaption are health, quality of life and death with dignity (Dixon, 2002).

Within the Roy’s Adaption Model, the person is defined as a bio-psycho-social human-being who is in continuous interaction with an altering environment. Environment refers to internal and external stimuli that surrounds and influences the person or group’s behavior. Health is the goal and is defined as a state of being and becoming whole. The process of health is demonstrated by a health-illness continuum and is the result of adaptation (Dixon, 2002). Adaptation is defined as the process and result of the person thinking and feeling, using conscious awareness and intention to generate human and environment combination. There are three levels of adaption which include integrated, compensatory and compromised. An integrated life process may transform into a compensatory process, which acts to restore integrity. If the compensatory processes are insufficient, compromised processes will occur. There are two coping mechanisms including innate and acquired. Innate coping mechanisms are generally unconscious responses and are inherently determined. Acquired coping mechanisms are learned behavior or develop through expected responses. Further in coping processes are the terms of regulator and cognator subsystems applying to the person, and stabilizer and innovator subsystems applying to groups. These life processes are demonstrated in person and group behaviors (Dixon, 2002). As stated previously, the four adaptive modes include physiological-physical, self-concept, role-function and interdependence. Within the physiological-physical mode, the behavior is the cell-level in the body. Five basic needs exist within the person including oxygenation, nutrition, elimination, activity and rest, and protection. The physiological adaption occurs within the senses; fluid, electrolyte and acid-base balance; neurological function; and endocrine function. The self-concept adaption mode includes components of the physical self and the basic need is for one to know oneself and exists with a sense of unity. The role-function mode focuses on the roles the person plays within society and within a group. The basic need is for social integrity, knowing who the person is within society and to behave within their role. The interdependence mode relates to relationships and the basic need is to feel secure within nurturing relationships (Dixon, 2002). These concepts are integrated into the development of Roy’s Adaption Model and influence the way it is utilized in research and nursing care.

Roy’s Adaption Model is widely utilized in research and applied to multiple different populations and areas of health care practice. Between the years of 1970-1994, there were 163 studies utilizing Roy’s Adaption Model as a basis for research studies as well as five middle-range theories that were developed between 1995-2010 (Roy, 2011). One study evaluated the effect of their education, exercise and social support within a randomized- controlled clinical trial on 43 adult patients with heart failure. The result of the study revealed that the intervention group positively adapted, and their quality of life was increased (Bakan & Akyol, 2008). Another study evaluated the effects of patient education in a medical semi-experimental research study on 59 adult hemodialysis patients. The results revealed an increase in adaption among the physiological, self-concept and role modes (Afrasiabifar, Karimi, & Hassani, 2013). Another study appraised the outcome of utilizing holistic care in conjunction with Roy’s Adaption Model among a patient undergoing breast conserving surgery. The study revealed positive adaption among the patient (Ursavas, Karayurt, & Iseri, 2014). Finally, another study revealed the positive outcomes of implementing Roy’s Adaption Model among pediatric patients (Saini, Sharma, Arora, & Khan, 2017). These studies just name a few of the many research studies employing Roy’s Adaption Model into patient care. As evident, implementing care based upon the model produces favorable patient outcomes of positive adaption, which results in optimal health. 

The Roy Adaption Model is frequently used in nursing practice. The nursing process has evolved over many decades and guides nursing care worldwide. The nursing process is one of the basic functions that nurses’ implement daily and is considered evidence-based practice as it has been widely researched (Toney-Butler, & Thayer, 2019). In order to use Roy’s Adaption Model in practice, the nurse is guided by Roy’s six-step nursing process which includes assessing behaviors, assessing stimuli, developing nursing diagnosis, creating goals, implementing interventions, and evaluating attainment of adaptive goals. The beginning two aspects of the nursing process involves the nurse assessing the patient’s behaviors and stimuli. Behaviors may include observable, such as a heart rate, or non-observable data, such as subjective data from the patient. In this phase, the nurse implements observational skills, instinct, measurements, and interviewing skills to gather all the information needed. In addition, the nurse considers internal and external environmental factors associated with the behaviors. The examination of the data collected is reflected in the nursing diagnosis and indicates the patient’s adaptive state. When creating a nursing diagnosis, the nurse creates language consistent with current mannerisms and stimuli (Daley, 1996). The next step is the planning process, which occurs when the nurse generates goals for the patient or group. The goals include the behavior observed and how they will adapt and have a measurable time frame for the goal to be achieved. The next step is implementation, and this happens when the nurse utilizes the interventions into the nursing process. The interventions are adjusted to encourage adaption by modifying the stimulus and promote coping mechanisms. Finally, the evaluation process appraises the interventions’ success upon the patient’s adaptive goals. Determining the effect of the intervention, the same process is utilized by the nurse in examining all data collected (Daley, 1996).  Along with using the Adaption model in the nursing process, the nurse can implement evidence-based practice in other areas of care as well. These areas include creating assessment and documentation methods that utilize areas of the model that are consistent with the patient population served; developing training tools based on the model into educating patients, families and/or team members; addressing any issues that arise in communication or role status; executing a committee to address any resistance to change; and raising awareness and promoting positive change through conferences, meetings and educational modules (Senesac, n.d.).

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 In summation, Roy’s Adaption model is extensively researched and executed within nursing education and practice. Nurses have the ability to encourage patients to positively adapt to their environment or stressors in order to achieve optimal health by utilizing the Roy’s Adaption model. This paper has explained how Sister Castilla Roy created the theory and defined the concepts within the theory. Furthermore, this paper has included multiple research studies that the Roy Adaption Model has been utilized as well as how the model is used within current nursing practice. As evident, Roy’s Adaption Model provides a necessary framework for all nurses to provide patient-centered, appropriate care within all populations for patients to attain optimal health and well-being.

References

• Afrasiabifar, A., Karimi, Z., & Hassani, P. (2013). Roy’s adaption model-based patient education for promoting the adaption of hemodialysis patients. Iranian Red Crescent Medical Journal, 15(7), 566-572. doi:10.5812/ircmj.12024
• Bakan, G., & Akyol, A. (2008). Theory-guided interventions for adaption to heart failure. Journal of Advanced Nursing, 61(6), 596-608. doi:10.1111/j.1365-2648.2007.04489.x
• Daley, B. (1996). Concept maps: Linking nursing theory to clinical nursing practice. The Journal of Continuing Education in Nursing, 27(1), 17-27. doi:10.3928/0022-0124-19960101-06
• Dixon, E. (2002). Community health nursing practice and the Roy adaption model. Public Health Nursing, 16(4), 290-300. doi:10.1046/j.1525-1446.1999.00290.x
• Roy, C. (2011). Research based on the Roy adaption model: Last 25 years. Nursing Science Quarterly, 24(4), 312-320. doi:10.1177/0894318411419218
• Saini, N., Sharma, V., Arora, S., & Khan, F. (2017). Roy’s adaption model: Effect of care on pediatric patients. International Journal of Nursing and Midwifery Research, 4(1), 52-60. doi:10.24321/2455.9318.201708
• Saleh, U. (2018). Theory guided practice in nursing. Journal of Nursing Research and Practice, 2(1), 18. Retrieved from https://www.pulsus.com/scholarly-articles/theory-guided-practice-in-nursing.pdf
• Senesac, P. (n.d.). Implementing the Roy adaption model: From theory to practice. Retrieved from https://www.bc.edu/content/dam/files/schools/son_sites/theorist/pdf/Senesac, %20P%20-%20Implementing%20the%20Roy%20Adaptation%20Model.pdf
• Toney-Butler, T., & Thayer, J. Nursing process. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499937/
• Ursavas, F., Karayurt, O., & Iseri, O. (2014). Nursing approach based on Roy adaption model in a patient undergoing breast conserving surgery for breast cancer. Journal of Breast Health, 10(3), 134-140. doi:10.5152/tjbh.2014.1910