Roy conceptualizes the human system in a holistic perspective, as holism stems from the underlying philosophic assumption of the model. Holism is the aspect of unified meaningfulness of human behaviour in which the human system is greater than the sum of individual parts.

2. Introduction of author
 Born at Los Angeles,
California on October 14,
1939 as the 2nd child of Mr.
and Mrs. Fabien Roy .
 Sr.Callista Roy, a prominent
nurse theorist, writer,
lecturer, researcher and
teacher.

3.  Was Chairperson of department of Nursing in Mount
Saint Mary’s College, Los Angeles , California.
 Was Adjunct Professor of Graduate program, School
of Nursing, University of Portland, Oregon.
 Was Acting Director and Nurse Consultant in Saint
Mary’s Hospital, Tucson, Arizona.
 Is Professor and Nurse Theorist at the Boston
College of Nursing in Chestnut Hill.
 Roy is known worldwide for her work with the Roy
Adaptation Model.

4.  Honors and awards
 2006: Distinguished
Teaching Award, Boston
College
 2007: Living
Legend, American
Academy of Nursing
 2010: Inductee, Sigma
Theta Tau’s Nurse
Researcher Hall of Fame
 2011: Mentor Award,
Sigma Theta Tau Society
 Sr. Callista Roy, CSJ, PhD,
RN, FAAN
 Born: Callista Lorraine
Roy October 14, 1939
 Education:UCLA
 Years active: 1963–
present
 Known forAdaptation
model of nursing
 Medical career
Profession Nursing
professor Institutions
Boston College
 Research:Nursing theory

5. Origin of Roy’s Adaptation Model
 Roy adapted some of her theory development from
Harry Helson’s Adaptation Theory (Wikipedia 2011).
 Roy incorporated Helson’s theory with Rapoport's
definition of system to view the person as an adaptive
system (Alligood and Tomey 2010). She also used other
broad principles from Dohrenwend, Lazarus,
Mechanic, and Selye.
 Roy gave special credit to Driever, Martinez, and Sato
for their contributions.
 There were greater than 1500 scholars and students
who contributed to this model.(Alligood and Tomey
2010).

6. Major Concepts
 Adaptation -- goal of nursing
 Person -- adaptive system
 Environment -- stimuli
 Health -- outcome of adaptation
 Nursing- promoting adaptation and health

7. Elements in the Roy Adaptation
Model
 The person who is the recipient of nursing care
 The goal of nursing
 The concept of health
 The concept of environment
 The direction of nursing activities.

8. Person/ Human as adaptive
system
 The first area of focus is humans as adaptive systems,
both as individuals and in groups.
 The model offers the point of view or paradigm for
shaping nursing activities.
 The focus of nursing relationships and interactions
can be at the level of individual, group, organisation,
theses communities and societies in which they are
included.
 Any of can be considered as human system, and each
is considered by the nurse as a holistic adaptive
system. The idea of adaptive system combines the
concept of system and adaptation.

9. Contd……..
 Roy conceptualizes the human system in a holistic
perspective, as holism stems from the underlying
philosophic assumption of the model.
 Holism is the aspect of unified meaningfulness of
human behaviour in which the human system is greater
than the sum of individual parts.
 As living systems, persons are in constant interaction
with their environment.
 Characteristics of a system include includes inputs,
outputs, throughput (control processes and effectors)
and feedback.

10. The Person as an adaptive system
Input Processes Effectors Output
Stimuli
Adaptati
on
Level
Coping
Mechanism
Regulator
Cognator
Physiological
Function
Self Concept
Role Function
Interdependence
Feedback
Adaptive
And
Ineffective
Responses

11. Cont…..
 Roy's model sees the person as "a bio-psycho-social
being in constant interaction with a changing
environment".
 The person is an open, adaptive system who uses coping
skills to deal with stressor.
 System employs a feedback cycle of input, processes,
effectors and output.
 The human adaptive system has inputs of stimuli and
adaptation level, outputs as behavioural responses that
that serve as feedback, and control process known as
coping mechanisms.

12.  Input: is identified as stimuli and adaptation level (a
particular internal pooling of stimuli). The adaptation
level of the person is the function of the stimulus.
 Stimuli can come from the environment or from
within a person. Stimuli is classified into three types
which are:
 Focal stimuli
 Contextual Stimuli
 Residual stimuli

13. Focal stimuli
 Focal stimuli is the stimuli which is most
immediately confronting the human system.
 The focal stimulus demands the highest awareness
from human system.
 It is the centre of the system’s consciousness.
 When you look at a nursing diagnosis it is the related
to phrase; Impaired physical mobility r/t abdominal
incision pain , Anxiety r/t feelings of hopelessness and
helplessness secondary to new breast cancer diagnosis

14. Contextual stimuli
 Contextual stimuli are all other stimuli of human
system’s internal and external world that can be identified
as having a positive or negative influence on the situation.
We must know or have confirmed their influence on the
situation.
 Examples: past experiences, other health conditions, age,
gender, culture, spirituality, level of physical function,
family dynamics, economic status, knowledge base, values,
support systems in place

15. Residual stimuli
 Residual stimuli are those internal or external factors
whose current effects are unclear.
 In nursing practice, the nurse considers general knowledge
related to the event or situation that has possible but
unknown influences as residual stimuli.
 If we confirm that the stimuli is influencing we move it to
either F or C stimuli
 Along with stimuli, the adaptation level of human system
acts as important internal input to the system as adaptive
system.

16. Adaptation Level
 Adaptation level is combining of stimuli that represent the
condition of life processes for the human adaptive system.
 The adaptation level is the range of the response and the
unique to the individual.
 Each person’s adaptation level is constantly changing
aspect, which is influenced by coping mechanisms of that
person.
 Three level is defined by Roy mentioned below;

17. Integrated processes
 Integrated processes are present when the
adaptation level is working as a whole to meet the
needs of human system. Adaptation level where the
structures and functions of the life processes work to
meet needs.
 Examples of Integrated Adaptation
 Stable process of breathing and ventilation
 Effective processes for moral-ethical-spiritual growth

18. Compensatory processes
 Compensatory processes occur when the human’s
response systems have been activated.
 Adaptation level where the cognator and regulator are
activated by a challenge to the life processes.
Examples:
 Grieving as a growth process, higher levels of adaptation
and transcendence
 Role transition, growth in a new role

19. Compromised processes
 Compromised processes occur when the
compensatory and integrated processes are not
providing for adaptation.
 Adaptation level resulting from inadequate integrated
and compensatory life processes. Examples;
 Hypoxia
 Unresolved Loss
 Abusive Relationships

20. Line of adaptation
Adaptation
level
Stimuli
Adaptation
level
+R/Adaptation
stimuli
--R/Ineffective
response

21. Throughput
 Throughput makes use of person’s processes and
effectors.
 Processes refer to the control mechanism that a person
uses as an adaptive system.
 Effectors refer to the physiologic function, self-concept
and role function involved in adaptation.
 Roy present a unique nursing science concept of
control mechanism: the regulator and the cognator.

22. Regulator subsystem
 The regulator subsystem has component of input, internal
process, and output.
 Input stimuli may originate externally or internally to the
person.
 The transmitter of the regulator system are neural,
chemical, and endocrine in nature.
 Autonomic reflexes, which are neural responses originating
in the brain stem and spinal cord, are generated as output
responses of the regulator system.
 Target organ and tissues under the endocrine control also
produce regulator output response.

23. Cognator subsystem
 The cognator processes also consists of input, internal
processes and the output.
 It regulates self-concept, role function, and interdependence.
 Cognator control process are related to the higher brain
function of perception or information processing, learning,
judgment and emotion.
 perception or information processing is related to the internal
process of selective attention, coding and memory.
 Learning is correlated to the process of imitation,
reinforcement and insight.
 Problem solving and decision making are the internal process
related to judgment and emotion has the internal process of
defence to seek relief, affective appraisal and attachment.

24. The four adaptive modes
 Adaptive modes are parts of the internal processes and act
as system effectors.
 Adaptive modes are categories of behavior to adapt to
stimuli.
 Adaptive modes include physiologic function, self-concept,
role function and interdependence.
 Coping mechanism can be used to identify adaptive or
ineffective responses by observing the person’s behaviour
in relation to the adaptive modes.

25.  The physiological physical mode involves
the bodies basic need ways to adapt.
 It includes a person’s pattern of oxygenation,
nutrition, elimination, activity and rest, skin
integrity, senses, fluids and electrolytes,
neurological and endocrine function.
 Physiologic mode is less abstract then other
three adaptive modes.

26.  These above needs and processes may be defined
as:
 Oxygenation: the processes of ventilation, gas
exchange and transport of gases.
 Nutrition: patterns of nutrients used for maintaining
human functioning, promoting growth, and repairing
injured tissue.
 Elimination: patterns of elimination or waste products.
 Acting and rest: patterns of activity and rest.
 Protection: patterns related to skin integrity and
immunity.

27.  Senses: the input channel of the person through which
sensory perceptual information is processed.
 Fluid and electrolyte: the complex process of maintaining
body fluid and electrolytes in balance for the person.
 Neurological function: key neural process and complex
relationship of neural function to regulator and cognator
coping mechanism.
 Endocrine function: patterns of endocrine control and
regulation that act in conjunction with nervous system to
maintain control of the body processes.

28.  The self-concept mode refers to beliefs and feelings about
oneself.
 For individuals, the self-concept mode relates to the basic
need for psychic and spiritual integrity or a need to know
the self with the sense of unity.
 Self-concept is central to the person’s behavior because it
consists of the person’s belief or feelings about himself or
herself at any given time.
 Self-concept comprises the physical self (includes
sensation and body image), personal self (includes self-
consistency and self-ideal) and moral and ethical self
(includes self-observation and self-evaluation).

29. The role function mode
 The role function mode involves behavior based on a
person’s position in the society. Role function is
depending on how the person interacts with other in a
given situation.
 It can be classified as primary (age, sex), secondary
(husband, wife), or tertiary (temporary role of the
coach).
 The role underlying this mode is social integrity.
 The mode includes functions of the members of the
administration and staff, information management,
decision making systems, systems to maintain order or
the need for group members to understand and
commit to fulfilling expected responsibility.

30. Interdependence
~ RELATIONSHIPS ~

31. The interdependence mode
 The interdependence mode involves a person’s
relationship with significant others and support
system.
 Interdependence meets a person’s need or love,
nurturing and affection.
 The mode focuses on giving and receiving love, respect
and value.

32. OUTPUT (BEHAVIORS)
 Outputs of the human adaptive system are behavioral
responses.
 Output responses can be both external and internal;
thus these responses are the system’s behaviors.
 They can be observed, intuitively perceived by the
nurse, measured and subjectively reported by the
human system.

33. Cont…………..
 Output responses become feedback to the system and to
the environment.
 Roy categorizes output of the systems as either adaptive
response or ineffective responses.
 Adaptive responses are those that promote the integrity
of the human system.
 The system’s integrity or wholeness is behaviorally
demonstrated when the system is able to meet the goal
in terms of survival, growth, reproduction, mastery or
transformation of the system and the environment.

34. Cont….
 An example of family adaptation might include reporting
the ability to establish, and satisfaction with breastfeeding
a newborn.
 If however the stimuli are too great, the adaptation made in
response will not be able to maintain integrity and are
seen as maladaptive or negative.
 Ineffective responses in the other hand do not support the
goals of humans as adaptive systems. Ineffective response
can immediately or gradually threaten the systems survival,
growth, reproduction, mastery of transformations.

35. Goal of the nursing:
 Roy defines the goal of nursing as the promotion of
adaptive responses in relation to four adaptation
modes: physiological-physical, self-concept group
identity, role function and interdependence.
 Adaptive responses are those that positively affect
health, that is, support the integrity of human
adaptive system.
 In the perspective of RAM, human responses include
not only problems, needs and deficiencies but also
capacities, assets, knowledge, skill, abilities and
commitments.
 All responses are behavior.

36.  Cont….
 When the total stimuli (focal, contextual and residual) fall
within the person’s zone of adaptation, an adaptive response
results.
 But when the total stimuli fall above the person’s zone of
adaptation ineffective output behaviors of response occur, where
nursing requires.
 Nursing seeks to reduce in ineffective responses and promote
adaptive responses as output behavior of the person.

37. Cont….
 Nursing include assessment, diagnosis, goal setting,
intervention and evaluation.
 Nursing focus on persons, family, groups or
community with ineffective behavior and on
manipulation of stimuli so that they could fall within
the patient’s adaptive zone.

38. The concept of health:
 Health is “a state and process of being and becoming
an integrated and whole person”.
 The integrity of the person is expressed as the ability
to meet the goals of survival, growth, reproduction,
mastery and person and environment transformation.
 Roy states that the term integrity is used to mean
“soundness or an unimpaired condition leading to
wholeness”.

39. Cont…
 One’s sense of purpose of life and the meaning of life,
according to Roy are significant factors relating to
integration and wholeness.
 This view of health transcends a simple absence of disease.
In fact health, as viewed in this perspective can exist for
persons with physical emotional or other changes.
 Health in the RAM is a state and a process of integration
that indicates successful adaptation.

40.  Health was originally described by Roy as a health
illness continuum, with one end of the continuum
being death and the other end wellness; health and
illness were considered an inevitable dimension of
person’s life.
 In other word, health is the state of adaptation that is
manifested in free energy to deal with other stimuli.
 Health is the process of promoting integrity.

41. The concept of environment:
 All conditions, circumstances or changes which challenge
the person as an adaptive system are considered as
environment.
 The person is constantly interacting with the continuously
changing environment. Both internal and external factors
are identified as stimuli that affect people’s behavior or
development.
 Roy specifically defines environment as “all conditions,
circumstances and influences that surrounds and affect the
development and behavior of humans as adaptive systems,
with particular consideration of person and earth
resources”.

42. Nursing activities
 Nursing activities are delineated by the model as those that
promotes adaptive responses in situations of health and illness.
 Nursing activities includes the manipulation of focal, residual
and contextual stimuli within the patient’s zone of positive
coping.
 Whenever possible, in the first the focal stimulus is
manipulated.
 When the focal stimuli cannot be altered, the nurse promotes
the adaptive response by manipulating contextual and residual
stimuli.
 Besides this, the nurse may anticipate that the person has a
potential for ineffective responses secondary to stimuli likely to
be present in a particular situation.

43. The Metaparadigm Of RAM
 Person
 Health
 Environment
 Nursing

44. Person
 Bio-psycho-social being in constant interaction
with a changing environment
 An adaptive system described as a whole
comprised of parts
 Uses innate and acquired mechanisms to adapt
 Functions as a unity for some purpose

45. The concept of environment:
 All conditions, circumstances or changes, which
challenge the person as an adaptive system, are
considered as environment.
 The person is constantly interacting with the
continuously changing environment.

46. Concept of Health
 Health is “a state and process of being and becoming an
integrated and whole person.
 The integrity of the person is expressed as the ability to meet the
goals of survival, growth, reproduction, mastery and person and
environment transformation.

47. Nursing
 Nursing is the science and practice that expands
adaptive abilities and enhances person and
environment transformation
 Nursing goals are to promote adaptation for individuals
and groups in the four adaptive modes, thus
contributing to health, quality of life, and dying with
dignity
 This is done by assessing behavior and factors that
influence adaptive abilities and by intervening to
expand those abilities and to enhance environmental
interactions

49. APPLICATION OF THE
THEORY

50. Application to Nursing Practice
Nursing Process
1. Assess Behavior
2. Assess Stimuli
3. Nursing Diagnosis
4. Goal Setting
5. Interventions
6. Evaluation

51. Situation 1
Mr. X, 60 years, male with a past history of diabetes
for 10 years was admitted for amputation of
great and second toe due to foot ulcer. He was
discharged after a month of admission but was
readmitted as the amputated wound developed
infection and the doctor has now suggested below
knee amputation.

52. Demographic Data
Name: Mr. X
Age: 58 years
Sex: Male
IP number: ……….
Education: ……….
Occupation: ……….
Marital status: ……….
Religion: ……….
Informants: ……….
Date of admission: ……….

53. First level assessment
Physiologic-physical mode
Oxygenation
Stable process of ventilation and gas exchange? RR?
Chest shape. Chest expansion on both sides.
Air entry. Added breath sound.
Heart sounds

54. Physiological-Physical mode Cont….
Apex beat: rhythm, depth and rate.
BP
Capillary refill
Peripheral pulsations including that of affected limb:
rate, depth, tension, rhythm
Clubbing / cyanosis.

55. Physiologic-physical mode contd…
Nutrition
 Diabetic diet. Total allowed calorie intake. Veg/Non
veg.
 Weight loss and its rate.
 Digestive problems? Bowel sounds?
 Food intake.
Elimination
 Any signs of infections or pain during micturation or
defecation.
 Bladder pattern. Self voiding or using bedpan, urinal?
 Bowel pattern. Any complains of constipation.

56. Physiologic-physical mode contd…
Activity and rest
 Rest pattern
 Sleep pattern
 Any relaxation techniques used
 Recreational habit
 Activity level and exercise
 Needs assistance for doing activities?

57. Physiologic-physical mode contd…
Protection
 Skin condition
 Peripheral pulses
 Condition of amputated foot.
 Healing process
 Any redness, discharge or other signs of
infection.
 Temperature
 Immunity conditions

58. Physiologic-physical mode contd…
Senses
 Any pain sensation from the wound site.
 Sense of touch, taste, vision and hearing
 Integration of sensory inputs into information
 Patterns of perception, interpretation & appreciation of
input
 Any coping strategy
Fluids and electrolytes
 Water balance. Intake output
 Serum electrolyte values
 Acid base balance
 Other lab values.

59. Physiologic-physical mode contd…
Neurological function
 Process of arousal and attention, sensation and
perception, coding and concept formation, planning and
motor response
 Consciousness, orientation.
 Any signs of stress.
 Thinking, feeling, memory and language
 Senses of touch
Endocrine function
 Insulin function.
 Any S/S of endocrine disorders, enlarged glands.
 Hormonal regulation

60. Self concept mode
Physical self
 Body image
 Anxiety and coping strategies for bodily changes
 Members in the family, relationship with family members
and neighbors.
 Any local social activities.
Personal self
 Pattern of self consistency
 Disturbance in self esteem, financial status (may be
bread winner),
 Religious perspective
 Coping strategies for threats to self

61. Role performance mode
 Position and role in the family and how the patient is
coping with this.
 Role clarity
 Process of role transition, coping with role changes
 Group role integration

62. Interdependence mode
 Interaction with friends, neighbors, relatives and his
interdependence with them.
 Developmental adequacy
 Pattern of giving and receiving
 Coping strategies for separation and loneliness

63. Second level assessment
Focal stimulus
 Non-healing wound after amputation of great and
second toe of left leg.
 History of present illness, where the patient
consulted first and his progress to the present
condition.
Contextual stimuli
 Known case DM for past 10 years. Medications used,
any family environmental factors or habits (eg: did
not use slippers at home)
Residual stimuli
 Any past illness, hospitalization, medications

64. Strengths RAM
 It focuses on inclusion of the whole person or
group
 The concepts of RAM are clearly and consistently
defined and are interrelated.
 It is internally consistent, even though it is a
complex model with several major concepts, sub-
concepts, and many relational statements.
 Contribute to and assist in increasing the general
body of knowledge of a discipline
 Can be utilized by the practitioners to guide and
improve their practice

65. Strengths contd…
 It has the level of complexity required to make it broad in
scope and generalizable for both practice and research;
however, once learned, the model is logical and easy to
understand.
 The four modes provide an opportunity for consideration
of multiple aspects of the human adaptive system and
support gaining an understanding of the whole system.

66. Strengths contd…
 It is evolving because of research
 Can be the basis for the hypotheses that can be
tested
 Consistent with other validated theories, laws and
principles

67. Limitations
Weaknesses have been identified in relation to:
Research:
 Need for consistent definitions of the concepts and
terms
Practice:
 Time constraints: the amount of time required to
fully implement the areas of assessment of RAM may
be viewed as insurmountable( impossible)

68. Usefulness of Adaptation Model
 Scientific knowledge for practice
 Clinical assessment and intervention
 Research variables
 To guide nursing practice
 To organize nursing education
 Curricular frame work for various nursing colleges

70. In practice
With use of Roy’s six steps nursing process, the
nurse:
 Assesses the behaviour manifestation from the
four adaptive mode
 Assesses the stimuli for those behaviours and
categories them as focal, contextual or residual
stimuli
 Makes a statement or nursing diagnosis of
person adaptive state
 Sets goals to promote the adaptation

71. Practice contd…
 Implements interventions aimed at maintaining the
stimuli to promote the adaptation
 Evaluates whether the adoptive goals have been
met
 By manipulating the stimuli and not the patient the
nurses enhances the interaction of the person with
their environment there by promoting the health. It
is the valuable theory for nursing practice because it
include a goal that is specified as the aim for
activities and prescription for activities to realize the
goal

72. In Education
 The adaptation model has been useful in the
educational setting and is currently in use at Mount
Saint Mary’s college, Department of nursing in Los
angles. The model allow increasing knowledge in the
area of both theory and practice.
 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 mode in
situation of health and illness.

73. Education contd……
 In1976 the model was used for curriculum
development of a practitioner programme at the
university of Miami, Florida.
 Organization of curriculum content and selection of
students for the learning experiences were derived
from the model.
 Application of model resulted in decreased anxiety in
the students and provided framework to give
direction to the education of practitioners.

74. Education contd……
 Many nurses, as well as schools of nursing, have
adopted the Roy adaptation model as a framework for
nursing practice.
 The model views the client in a holistic manner and
contributes significantly to nursing knowledge.
 The model continues to undergo clarification and
development by the author.

75. In Research
 Development and testing of the theory: Roy
has stated that theory development and testing of
developed theory are nursing’s highest priorities. The
model must be able to generate testable hypothesis
for it to be researchable.
 Development of adaptation research instruments by
the use of self concept adaptive mode, Phillips
developed the Phillips stigma questionnaire in
AIDS to measure internalized stigma in person with
AIDS

76. Research studies using RAM
 Middle range theories have been derived from RAM
 1998-Ducharme et al described a longitudinal model of
psychosocial determinants of adaptation
 1998-Levesque et al presented a MRT of psychological
adaptation
 1999-A MRNT , the urine control theory by Jirovec et al
 Dunn, H.C. and Dunn, D. G. (1997). The Roy Adaptation
Model and its application to clinical nursing practice.
Journal of Ophthalmic Nursing and Technology. 6(2), 74-
78.

77.  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. 28(6), 1259-
1268.
 Chiou, C. (2000). A meta-analysis of the interrelationships
between the modes in Roy's adaptation model. Nursing
Science Quarterly. 13(3), 252-258
 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

78. References
Adhikari, R. D. (2010). Nursing theories and modules (2nd ed).
Makalu Publication House: Dillibazar, Kathmandu.
George, J. B. (2011). Nursing theories: the base for professional
nursing practice (6th ed). Pearson, India
Rai, L. (2011). Nursing Concepts Theories and Principles (2nd
edition ed.). Udayapur: Nabin Kumar Rai.
Raj, D. E. (2011). Nursing Theories A practical View. New Delhi:
Jaypee Brothers Medical Publisher (Pvt.) Ltd.