nurse theorist, writer, lecturer,
researcher and teacher
Professor and Nurse Theorist at the
Boston College of Nursing in Chestnut
Born at Los Angeles on October 14,
Bachelor of Arts with a major in
nursing - Mount St. Mary's College,
Los Angeles in 1963.
Master's degree program in pediatric
nursing - University of California, Los
Angeles in 1966.
Master’s and PhD in Sociology in
1973 and 1977.
Worked with Dorothy E. Johnson
Worked as f faculty of Mount St.
Mary's College in 1966.
Organized course content
according to a view of person
and family as adaptive systems.
RAM as a basis of curriculum at
Mount St. Mary’s College
1970 - The model was
implemented in Mount St.
1971- she was made chair of the
nursing department at the
Roy’s Adaptation Model for Nursing was derived
in 1964 from Harry Helson’s Adaptation
Theory – adaptive responses are a function of
the incoming stimulus and the adaptive level
Roy combines Helson’s work with Rapport’s
definition of system and views the
person as an adaptive system.
After the development of her theory, Roy developed
the model as a framework for nursing practice,
research, and education.
According to Roy, more than 1500 faculty and
students have contributed to the theoretical
development of the adaptation model.
The model uses concepts from AH Maslow to
explore beliefs and values of persons. Roy’s holistic
approach to nursing is based in humanism.
A pilot research study and a survey research
study from 1976 to 1977 led to some tentative
confirmations of the model.
From this beginning, the adaptation model has
been supported through research in practice and
A set of units so related or connected as to form
a unity or whole and characterized by inputs,
outputs, and control and feedback processes.
A constantly changing point, made up of focal,
contextual and residual stimuli, which represent
the person’s own standard of the range of stimuli
to which one can respond with ordinary adaptive
The occurrences of situations of inadequate
response to need deficits or excesses.
Seen not as nursing diagnosis, but areas of
concern for the nurse related to adapting person
or group (Within each adaptive mode)
Focal Stimulus – the degree of change or stimulus most
immediately confronting the person and the one to which
the person must make an adaptive response, that is, the
factor that precipitates behavior
Contextual Stimuli – all other stimuli present that
contribute to the behavior caused or precipitated by the focal
Residual Stimuli – factors that may be affecting
behavior but whose efforts are not validated
Regulator – subsystem coping mechanism
which responds automatically through neural-
Cognator - subsystem coping mechanism
which responds to complex processes of
perception and information processing,
judgment, and emotion.
Adaptive Responses – responses that
promote integrity of the person in terms of goals
of survival, growth, reproduction, and mastery
Ineffective Responses – responses that do
not contribute to adaptive goals, that is, survival,
growth, reproduction, and mastery
1. Physiological Mode – involve the body’s basic
needs and ways of dealing with adaptation in
regard to fluid and electrolytes; exercise and rest;
elimination; nutrition; circulation and oxygen; and
regulation, which includes the senses, temperature
and endocrine regulation
2. Self-Concept Mode – the composite of beliefs
and feelings that one holds about oneself at a given
time. It is formed from perceptions, particularly of
other’s reactions, and directs one’s behavior.
(physical self and personal self)
3. Role Performance Mode – role function is the
performance of duties based on given positions
4. Interdependence Mode – involves one’s
relations with significant others and support
systems. In this mode one maintains psychic
integrity by meeting needs for nurturance and
The person is a bio-psycho-social being.
The person is in constant interaction with a
To cope with a changing world, person uses both
innate and acquired mechanisms which are
biological, psychological and social in origin.
Health and illness are inevitable dimensions of
the person’s life.
To respond positively to environmental changes, the
person must adapt.
The person’s adaptation is a function of the stimulus
he is exposed to and his adaptation level
The person’s adaptation level is such that it
comprises a zone indicating the range of stimulation
that will lead to a positive response.
The person has 4 modes of adaptation: physiologic
needs, self- concept, role function and inter-
• A “theoretical system of
knowledge which prescribes a
process of analysis and action
related to the care of the ill or
potentially ill person.”
• Roy differentiates nursing as a
science from nursing as a
• A “biopsychosocial being in constant
interaction with a changing environment.”
• The recipient of nursing care, as a living,
complex, adaptive system with internal
processes (cognator and regulator) acting
to maintain adaptation in the four
adaptive modes (physiological needs, self-
concept, role function, and
• The person as a living system is “a whole
made up of parts of subsystems that
function as a unity for some purpose.”
• A “state and a process of
being and becoming an
integrated and whole person.
Lack of integration
represents lack of health.”
• “all the conditions, circumstances,
and influences surrounding and
affecting the development and
behavior of persons or groups. ”
• The input into the person as an
adaptive system involving both
internal and external factors (may be
slight or large, positive or negative)
• Any environmental change demands
increasing energy to adapt to the
situation. Factors in the environment
that affect the person are categorized
as focal, contextual, and residual
Outcome Theory - well articulated
conception of man as a nursing client and of
nursing as an external regulatory mechanism.
Both deductive and inductive
Deductive – derived from Helson’s Theory. Helson developed the
concepts of focal, contextual, and residual stimuli, which Roy defined
within nursing to form a typology of factors related to adaptation
levels of persons. Roy also uses other concepts and theory outside
the discipline of nursing and relates these to her adaptation theory.
Inductive – she developed the four adaptive modes from research
and practice experiences of herself, her colleagues, and her students.
Roy built on the conceptual framework of adaptation and as a result
developed a step-by-step model by which nurse use the nursing
process to administer nursing care to promote adaptation in
situations of health and illness.
Useful for it outlines the features of the discipline and
provides direction for practice
The model considers goals, values, the client, and
Using Roy’s six-step nursing process, the nurse:
1. Asesses behaviors
2. Asseses stimuli
4. Sets goals to promote adaptation
5. Nursing interventions
The model is a valuable tool to analyze overlap
and distinctions between the professions of
nursing and medicine.
Throughout the 1970’s and 1980’s, Roy’s model
has been implemented as a basis for curriculum
development in associate degree diploma,
baccalaureate, and higher degree programs in
The model does generate many testable
hypothesis related to practice and theory.
Middle range theories have been derived from RAM
› Samarel, N., Fawcett, J., Krippendorf, K., Piacentino, J.C., Eliasof, B., Hughes,
P., Kowitski, C., and Ziegler, E. (1998). Women's perception of group
support and adaptation to breast cancer. Journal of Advanced Nursing.
› Yeh, C. H. (2001). Adaptation in children with cancer: research with Roy's
model. Nursing Science Quarterly. 14, 141-148.
› Zhan, L. (2000). Cognitive adaptation and self-consistency in hearing-
impaired older persons: testing Roy's adaptation model. Nursing Science
Quarterly. 13(2), 158-165.
Clarity - logical; claims to follow a holistic view
but leaves out “spiritual, humanistic, and
existential aspects of being a person”
Simplicity – has several major concepts and
subconcepts and numerous relational
Generality – generalizable to all settings in nursing
practice, but is limited in scope because it primarily
addresses the concept of person-environment
adaptation and focuses primarily on the client
Empirical Precision – Testable hypothesis have been
derived from the model
Derivable Consequences – has a clearly defined
nursing process and can be useful in guiding clinical
practice; capable of generating new information
Trivia: While working toward her master’s degree, Roy was challenged in a seminar with Dorothy Johnson to develop a conceptual model for nursing. Roy had worked as a pediatric staff nurse and had noticed the great resiliency of children and their ability to adapt in response to major physical and psychological changes. Roy was impressed by adaptation as an appropriate conceptual framework for nursing. The basic concepts of the model were developed while Roy was a graduate student ast UCLA from 1964 to 1966.
Physical self-involves sensation and body image
Personal self-made up of self-consistency, self-ideal or expectancy, and the moral, ethical self
Assumptions From Systems Theory
A system is a set of units so related or connected as to form a unity or whole.
A system is a whole that functions as a whole by virtue of the interdependence of its parts.
Systems have inputs , outputs, and control and feedback processes.
Input, in the form of a standard or feedback, often is referred to as information.
Living systems are more complex than mechanical systems and have standards and feedback to direct their functioning as a whole
Assumptions from Helson’s Theory
Human behavior represents adaptation to environmental and organismic forces.
Adaptive behavior is a function of the stimulus and adaptation level, that is, the pooled effect of the focal, contextual, and residual stimuli.
Adaptation is a process of responding positively to environmental changes. This positive response decreases the response necessary to cope with the stimuli and increases sensitivity to respond to other stimuli.
Responses reflect the state of the organism as well as the properties of stimuli and hence are regarded as active processes.
Assumptions from Humanism
Persons have their own creative power.
A person’s behavior is purposeful and not merely a chain of cause and effect.
Person is holistic.
A person’s opinions and viewpoints are of value.
The interpersonal relationship is significant.
Roy derived this definition from the thought that adaptation is a process of promoting physiological, psychological, and social integrity, and that integrity implies an unimpaired condition leading to completeness or unity. In her earlier work, Roy viewed health along a continuum flowing from death and extreme poor health to high-level wellness and peak wellness. As man moves along the health-illness continuum, he encounters problems to which he must adapt. However, Roy’s recent writings have focused more on health as a process.
Roy’s model focuses on the concept of adaptation of man. Her concepts of nursing, person, health and environment are all interrelated to this central concept. The person continually scans the environment for stimuli so he can respond and ultimately adapt. Nursing has a unique goal to assist the person in his adaptation effort by managing the environment. The result is attainment of an optimum level of wellness by the person.
As an open, living system, the person receives input or stimuli from both the environment and the self. The adaptation level is determined by the combined effect of the focal, contextual, and residual stimuli. Adaptation occurs when the person responds positively to environmental changes. This adaptive response promotes the integrity of the person, which leads to health. Ineffective responses to stimuli leads to disruption of the integrity of the person.
There are 2 interrelated subsystems in Roy’s Model. The primary, functional, or control processes subsytem consists of four adaptive modes: physiological needs, self-concept, role function, and interdependence.
Roy views the regulator and cognator as methods of coping. Perception of the person links the regulator with the cognator in that “input into the regulator is transformed into perceptions. Perception is a process of the cognator. The responses following perception are feedback into both the cognator and the regulator.”
The four adaptive modes of the second subsystem in Roy’s model provide form or manifestations of cognator and regulator activity. Responses to stimuli are carried out through these four modes. The mode’s purpose is to achieve physiological psychological, and social integrity. Interrelated propositions of the cognator and regulator subsystems link the systems of adaptive modes.
Man as a whole is made up of 6 subsystems. These subsystems-the regulator, cognator, and the four adap[tive modes-are interrelated to form a complex system for the purpose of adaptation. Relationships between the four adaptive modes occur when internal and external stimuli affect more than one mode; when disruptive behavior occurs in more than one mode; or when one mode becomes the focal, contextual, or residual stimulus for another mode.
Three types of nursing theorists: those who focus on needs, those who focus on interaction, and those who focus on outcome
Deductive – derived from Helson’s Theory. Helson developed the concepts of focal, contextual, and residual stimuli, which Roy defined within nursing to form a typology of factors related to adaptation levels of persons. Roy also uses other concepts and theory outside the discipline of nursing and relates these to her adaptation theory.
Inductive – she developed the fur adaptive modes from research and practice experiences of herself, her colleagues, and her students Roy built on the conceptual framework of adaptation and as a result developed a step-by-step model by which nurse use the nursing process to administer nursing care to promote adaptation in situations of health and illness.
Mount Saint Mary’s College - current
University of Ottawa School of Nursing – 1980’s
University of Miami practitioner program - 1976