Nursing has developed into a profession, in which many theories have been developed and presented in order to lend guidance for purposeful and meaningful practice. In general, nursing theories are based on four concepts that collectively make up the nursing metaparadigm: person, environment, health, and nursing. These four concepts represent a commonality in the nursing profession (Tourville & Ingalls, 2003). This paper will discuss the Roy’s Adaptation Model (RAM) and include a brief introduction to the theory, the rationale for selection of the theory, an overview of the theory concepts, the application of the theory to nursing practice, the benefits of the model to patient care and an educational proposal on introducing the model to a practice group. Brief Introduction of Roy’s Adaptation Model
RAM was developed by Sr. Callista Roy, and first introduced as a nursing school model in 1970. This model has been widely applied in nursing practice, education and research. The basis of this model is on the assumption that each person is a bio-psycho-social being and is in constant interaction with a changing environment. The ability of the person to cope and positively adapt to change has a direct relationship on the overall health and wellness that is experienced by the person (Tourville & Ingalls, 2003). Rationale for Selection
The rationale for choosing RAM is that the model can be applied easily to a wide variety of clinical experiences, showcasing the ability of this theory to relate to the constant change in priorities, complexities, populations and communities. This supports the basis that RAM is a problem solving approach when applying the nursing process and as it pertains to the basic needs of health, quality of life, and dying with dignity in the life experience (CSU, 2015). When considering this selection, recent and ongoing world events have highlighted the importance of adaptation skills in a changing culture consumed by war, violence, community unrest and individual suffering. These factors must be considered when caring for our clients, as each one brings a unique life experience to their health journey. The ability to apply RAM to the nursing process will enhance the ability to care for the client in a holistic manner, taking into consideration the unique dimensions of a person’s life. Overview of the Theory Concepts
Roy describes health and illness as a state or process of being and indicates that becoming integrated as a whole is a necessary dimension of a human beings life. The person utilizes various mechanisms to adapt to changing situations and environments. This model includes people as individuals, families and societies (Nursing Theory, 2013). Adaptation is the goal of nursing, in which the person responds in a positive way to environmental changes by using conscious awareness, self-reflection and individual choice to become integrated in the situation. The four adaptive modes are physiological, self-concept, role function, and inter-dependence (Nursing Theory, 2013). The physiological mode is the maintenance of the physical body. Self-concept refers to the mind and spirit, which includes life-meaning and purpose. Role function is the maintenance of social integrity during different stages of life.
Inter-dependence involves the maintenance of positive and meaningful relationships with self and others (McEwen & Wills, 2014; Nursing Theory, 2013). According to Roy’s model, the goal of nursing is to stimulate adaptation of the patient during health and illness in all four adaptive modes, which contribute to health, quality of life and dying with dignity. In order for the nurse to assist the individual, there are two levels of assessments: behavior and stimuli. The behavior assessment can determine the presence or absence of adaptation. The assessment of stimuli, both internal and external, can reveal that which can influence the adaptive behavior. Nursing process continues with nursing diagnosis, goal setting, interventions, including a plan of care, and lastly, evaluation of the intervention and how it relates to the nursing goals established (Nursing Theory, 2013). Applying Roy’s Theory in Nursing Practice
To support excellence in nursing practice, Roy’s Adaptation Model (RAM) guides nurses in developing effective care through the use of reasoning, critical thinking, and decision-making. With a focus on adaptation, RAM can be utilized as a framework to conceptualize and plan individualized patient care or may be applied in a limited context to develop interventions for distinct clinical populations (Senesac, 2013). Through the nursing process, patients are assisted in adapting, or coping, to changes within their environments. The process begins with an assessment of the patient’s adaptive behavior as well as stimuli in the external and internal environments. Based on these evaluations, the nurse develops nursing diagnoses and interventions to guide goal setting and increase successful adaptations or coping mechanisms (Chitty & Black, 2007). Simply stated, the nurse modifies the environment to promote and facilitate patient adaptation and restore balance. Adaptation is observed through modifications in behavior.
In the context of RAM, four modes of adaptation may occur: physiologic needs, self-concept, role function, and interdependence (Chitty & Black, 2007). Evaluation of these behaviors provides insight on the progress made toward the established goal and the effectiveness of the environmental modification, or nurse intervention. The use of RAM provides a comprehensive approach to the nursing process from the perspective of adaptation. As changes or stimuli occur in internal and external environments, a person’s ability to adapt can decrease effective coping mechanisms. Using RAM, nurses can improve and promote adaptation thereby improving coping mechanisms and restoring balance. Benefits of Roy’s Adaptation Model and Patient Care
According to McEwen and Wills (2014), RAM has been used extensively and as a method to help guide practice and to organize nursing education. Shosha & Kalaldeh (2012) indicate that RAM is one of the most “useful conceptual frameworks that guides nursing practice, directs research and influences education” (p. 26). Many organizations and institutions, both nationally and internationally, have adopted RAM and have incorporated the model into their curriculum. RAM has also inspired the development of other middle range nursing theories. It should also be noted that RAM is used in almost every country, Europe, Asia and South America (McEwen & Wills, 2014).
What makes the application of RAM very beneficial is the simple fact that it is testable and practical. According to the Boston Based Adaptation Research in Nursing Society (BBARNS), 163 studies have been conducted, since the 1970’s, using this particular model (McEwen & Wills, 2014). This is due to the fact that the model “provides valuable information about individuals’ adaptation to different environmental stimuli” (Shosha & Kalaldeh, 2012, p. 27). One particular study conducted by Shosha & Kalaldeh (2012), included a critical analysis of ten different published studies, randomly selected, that utilized RAM and for various different application purposes. Of the ten studies analyzed, eight supported the utilization of RAM as an applicable, effective framework and useful model that can be used in nursing research. When considering Roy’s theory and patient care, Roy (2009) defines health as “a state and process of being and becoming an integrated and whole that reflects person and environment mutuality” (p. 12).
The person is a holistic adaptive system that is in constant interaction with the internal and the external environment. As a result, the care provided should focus on “human life processes and patterns of people with a commitment to promote health and full life-potential for individuals, families, groups, and the global society” (Roy, 2009, p. 3) and should focus on successful adaptation. Introducing and Educating Staff – Proposal for the Health Institution Sister Roy’s Theory unites conscious awareness and creates choice within the realm of human and environmental assimilation. There are four concepts of this model which include person, health, the environment and integration with nursing to appropriately establish RAM. Sister Roy’s goal of nursing is adaptation, with the purpose of enhancing quality of life and dying with dignity. Another goal is to support the caregivers throughout the disease process. According to Andrews (1992), the four modes consisting of physiological, self-concept, role function and interdependence, are explored with the patient alone, or may include family and caregivers.
The nurse also considers the interactions of the family with neighbors and other community support groups, to determine the need for respite, extended care vacations, or a period of rest for the immediate caregivers. Once the four modes have been identified, a six-step nursing process is initiated that includes an assessment of behavior, stimuli, nursing diagnosis, goal settings, interventions and a complete and frequent re-evaluation. One of Sister Roy’s goals for patients was for individuals to be an integrated and whole person. The proposal for hospital implementation and education is that the staff must be engaged with knowledge and enthusiasm along with the basics of education, process, and continuing education. All disciplines within the health care organization should be trained and awareness should be raised regarding the acceptable practice theory.
Ongoing education and competency is crucial to the success of the operational plan to implement the practice theory and monitor the outcomes of the plan. It should be communicated to the staff that there are no losers or failures. Plans may need to be adjusted or shifted depending on the situation. Something may have been overlooked regarding bedside care or perhaps the plan requires an adjustment based on the ergonomics of the organization, unit or patient population. Sister Roy’s Adaptation Theory was created to inspire and nurture nurses through daily teaching, research and utilizing the above mentioned six step nursing process. The model is very valuable in applying these processes into the patient’s life, along with their caregivers. Conclusion
Roy’s Adaptation Model is a nursing theory that can be applied in a variety of practice settings. The basic assumptions of the theory are both scientific and philosophical in nature, which rely heavily on the nursing process, clinical assessments and interventions. Research has shown that it is a desirable model to utilize in the clinical setting in order to guide practice, and as a method to organize education. By introducing Roy’s Adaptation Model as a reference to guide practice, it provides caregivers the opportunity to contribute to the health and wellness experience of the patient in an individual and holistic manner. More importantly, RAM allows each provider the ability to consider the individuals needs and coping methods, which in turn, can contribute to the overall satisfaction of the patient and caregiver experience throughout the health-illness continuum.
Andrews, H.; Roy, C. (1991). The Adaptation Model. Norwalk: Appleton & Lange Chitty, K.K., & Black, B.P. (2007). Professional nursing: Concepts and challenges (5th ed.). St. Louis, MO: Saunders Elsevier.
Clayton State University [CSU], (2015). Application of Roy’s adaptation model (RAM).Retrieved from http://www.clayton.edu/health/Nursing/Nursing- Theory McEwen, M., and Wills, E. M. (2014). Theoretical basis for nursing (4th ed.).Philadelphia: Lippincott Williams and Wilkins
Nursing Theory (2013). Sister Callista Roy:Nursing theorist. Retrieved from http://nursing-theory.org/theories-and-models/roy-adaptation-model.php Roy, Sr. C. (2009). The Roy Adaptation Model (3rd ed.). Upper Saddle River, NJ; Pearson Senesac, P. (2013). Implementing the Roy Adaptation Model: From theory to practice. Retrieved from http://www.bc.edu/schools/son/faculty/featured/theorist/Roy_Adaptation_ Model/Practice.html Shosha, G. A., & Kalaldeh, M. A. (2012). A critical analysis of using Roy’s adaptation model in nursing research. International Journal of Academic Research, 4(4), 26-31. doi:10.7813/2075-4124.2012/4-4/B.3 Tourville, C. & Ingalls, K. (2003). The living tree of nursing theories. Nursing Forum, 38(3), 21- 36. Retrieved from http://library.gcu.edu:2048/login?url=http://search. ebscohost.com/login.aspx?direct=true&db=a9h&AN=11354720&site=ehost-live&scope=sit