The Adaptation Model of Nursing by Sister Callista Roy
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Nursing theories are indispensable to the nursing practice for many reasons. They provide principles that strengthen nursing practice. Additionally, nursing theories help in the acquisition of nursing knowledge, which is necessary for the implementation of evidence-based practice (EBP). Therefore, it is important to combine theories with patient care. Significantly, professional nurses use a systematic approach of the theories to promote the health of individuals, families, and communities. The logical steps in the theories help the nurse to assess, diagnose, set goals, make appropriate interventions, and evaluate the outcomes of the patient’s condition.
Accordingly, theories provide a foundation on which to base the nursing practice and guide the nursing decisions to make them purposeful and useful. One such theory is the mid-range adaptation theory by Callista Roy. The current paper examines the background of Callista Roy, describes her theory of adaptation, evaluates its appropriateness in the nursing practice, and discusses its application in patient care.
The selected theory is a mid-range adaptation theory invented by Callista Roy. Its approach is useful to my practice setting because the patients under my care require their values to be respected. This theory enables me to consider the values and opinions of my patients and appreciate them. Various studies have examined this theory and found it applicable in many healthcare settings. From my literature search, I found the theory relevant to my healthcare environment. For instance, Bhanji (2012) made a comparison of Dorothea Orem's self-care theory and the adaptation theory by Callista Roy. The conclusion revealed that the adaptation theory by Callista Roy is relevant for patient care in many settings. Additionally, the theory improves the perception of nurses by providing a better image of the nursing profession (Bhanji, 2012, p. 52). Therefore, it allows me to work conscientiously to protect the esteem of the nursing profession.
Furthermore, the theory focuses not just on the disease but examines the social and psychological equilibrium with maladaptive responses, due to which nurses can come up with appropriate interventions (McCrae, 2012). In this theory, a nurse is a sole helper that facilitates the adaptation of the patient to the environment. Each patient adapts differently. Consequently, this theory is relevant to my setting because patients have unique problems. The theory has enabled me to examine the specific situations of every patient, allowing me to facilitate the efficient response of each patient to nursing care.
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Callista Roy was born to a Christian family in Los Angeles in the state of California on October 14, 1939 (Boston College, 2016). Her family had a deep spirit of hope, love, faith, commitment to God, and service to other people. These values enabled Dr. Roy to develop a genuine interest in other people. Her mother, being a licensed vocational nurse and possessing the Christian values, instilled in Dr. Roy the value of always seeking to know much about other people and helping them selflessly. During her school years, Dr. Roy noticed that she had excellent teachers who also assisted in cultivating her values. At the age of 14, Dr. Roy started working at a large general hospital. She started working as a pantry girl and later became a maid. Finally, she got the job of a nurse aid.
Dr. Roy then attended Mount St. Mary’s College in Los Angeles, where she acquired a Bachelor of Arts degree majoring in nursing. Dr. Roy then went for a Master’s degree in sociology and pediatric nursing at the University of California in Los Angeles. After that, she acquired a Ph.D. degree in sociology at the same university. She then completed a two-year post-doc in neuroscience at the University of California in San Francisco.
Based on the background, Dr. Roy appears as a woman who was interested in the nursing profession from a young age, considering that she began working as a nurse at the age of 14. She also grew up in a family that appreciated the values that are fundamental to the nursing profession. A combination of a genuine interest in nursing with its values placed Dr. Roy in a better position to contribute to the then growing body of knowledge in nursing. Besides, her theory was inspired by another nursing theorist (Dorothy Johnson) who analyzed her theory and approved it (Naga & Al-Atiyyat, 2014). Therefore, a combination of family and professional experience of Dr. Roy had a significant impact on theory development.
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The Literature on the Current Application of the Adaptation Theory
Frederickson (2011) wrote a detailed analysis of the adaptation theory by Dr. Roy. Frederickson is a founding member of the Roy Adaptation Association. The Roy adaptation theory has gone through various changes in the recent past, and its present state is backed by research conducted with the excellent methodological soundness (Frederickson, 2011, p. 302). Frederickson (2011) explains that the current work of Dr. Roy has extended from the clinical setting and is applied to the social needs of people internationally. For instance, when the earthquake occurred in Japan, the Roy Adaptation Association from the United States reached out to the authorities of the Roy Adaptation Association in Japan to help the victims.
Naga and Al-Atiyyat (2014) ascertain that the Roy adaptation theory is fundamental for nursing research, education, and most importantly, the nursing practice. Naga and Al-Atiyyat (2014) further argue that research evidence backs the adaptation theory and therefore, it is appropriate to apply this theory in the nursing practice (p. 18). This article further explains the crucial role that the adaptation theory plays in the delivery of nursing practice. The theory gives nurses a chance to think about people and the environment that is useful to them. Therefore, it ensures that nurses observe the behavior of their patients and facilitate proper interaction with the environment (Naga & Al-Atiyyat, 2014, p. 21).
For instance, Naga and Al-Atiyyat give the scenario of a patient suffering from cancer. The patient undergoes chemotherapy and radiotherapy and may experience physical problems such as pain, altered skin integrity, social isolation, and fatigue. The nurse needs to address the problems of the cancer patient in a holistic manner. Afterward, the nurse has to alleviate the pain that the patient has and conduct nursing education to make the family understand the role of caring for their family member. The nurse can also comfort the patient to be positive about life despite the ailment.
Consequently, the patient will adapt well to the environment by gaining comfort with less pain (physical adaptation), improved relationship with family and friends (social adaptation), and improved self-concept (psychological adaptation). The article concludes that the responsibility of the nurse is to identify factors that lead to maladaptation and promote the adaptation of all the four modes of the theory, thus improving the patient’s quality of life.
On the other hand, Bhanji (2012) argues that there are other theories better that the adaptation model to be applied in the nursing practice. Bhanji (2012) admits that the Roy adaptation theory is useful if applied across family groups and communities and not effective when caring for a patient (p. 52). However, this research does not dispute the adaptation theory but rather recommends its application to the nursing practice.
First, the adaptation theory addresses the psychological problems. According to this theory, a nurse needs first to assess the behavior of the patient and the way a patient responds to the environment. This theory appreciates the mental status of an individual by considering the behavioral aspects. In this case, some of the concerns of the patients that might need to be addressed include mood disorders, personality problems such as antisocial behavior, eating disorders, and depressive disorders.
Secondly, the theory helps people with various cognitive problems such as dementia and amnesia by helping such patients to respond effectively to their immediate condition (Shosha & Al Kalaldeh, 2012). The nurse can advocate for interventions both in the clinical setting and at home to help patients cope with cognitive behaviors in order to go on with their daily activities. Furthermore, the adaptation theory can assist people in performing their daily functions. For example, when a patient is sick, the nurse has to ensure that the patient gets cured to be in a better position to perform their expected daily functions.
Thirdly, the adaptation theory helps in solving the problems that people have concerning relationships. For instance, when some patients are hospitalized, their family members do not visit them, which can generate a feeling of worthlessness in the patient. Therefore, the nurse needs to explain the importance of visiting and interacting with the diseased to friends, relatives, and family to enable proper psychological adaptation.
Finally, the adaptation theory can be used to address the problems that people have outside the healthcare setting as in the case of disasters. Nurses can visit the affected places and offer psychological help to the victims to help them adapt to their environment and accept the situation (Frederickson, 2011).
The adaptation theory uses deductive reasoning. Deductive reasoning starts with a hypothesis and analyzes the possibility of reaching a logical conclusion (Lassiter & Goodman, 2015). This reasoning involves well-defined procedures, which one can use in coming up with consequences based on certain evidence. On the other hand, inductive reasoning goes beyond the available evidence and helps to come up with conclusions that are not necessarily true (p. 3). The Roy adaptation theory makes assumptions that human beings are bio-psycho-social beings (Shosha & Al Kalaldeh, 2012). It further assumes that people are in constant interaction with the environment, to which they need to adapt. The theory also assumes that for a person to cope with the world there is a need to use the acquired and innate mechanisms that are social, psychological, and biological in nature.
Moreover, the adaptation theory assumes that the person has four modes of adaptation, namely, physiologic needs, role function, self-concept, and interdependence (Shosha & Al Kalaldeh, 2012, p. 28). Therefore, this theory portrays a human being as having various features that are in constant relationship with the environment. On the basis of all the aspects that the theory considers, it is logical to conclude that the theory uses deductive reasoning because it is evident that the human body has several systems, which depend on each other and respond to the environment (National Cancer Institute, n.d.).
The Roy adaptation theory uses five main concepts. The concepts include adaptation, person, environment, health, and nursing (Shosha & Al Kalaldeh, 2012). The adaptation concept is a situation where a person responds effectively to environmental changes. Roy defined this adaptation aspect as the process and the outcome where the thinking person uses conscious awareness to create integration between the environment and the human perception (Shosha & Al Kalaldeh, 2012, p. 26). This concept is manifested by four interrelated modes of behavior. They include role function, self-concept, physiological and interdependence modes. The theory defines the person as a bio-psycho-social being who is always interacting with the changing environment. The person is comprised of parts, which are related to each other and must adapt to the environment for proper functioning.
The person is also depicted as having acquired the innate systems to adapt. Most importantly, the concept of a person includes families, communities, organizations, and society as a whole. Therefore, the theory targets the entire population. The environment concept is divided into stimuli. The stimuli include contextual, focal, and residual (Naga & Al-Atiyyat, 2014). The focal stimuli are the immediate being an apparent cause of the problems that need to be addressed (Naga & Al-Atiyyat, 2014, p. 19). The contextual stimuli involve factors that contribute to the focal stimuli. Therefore, the contextual stimuli cause the focal stimuli. Finally, the residual stimuli include unknown environmental factors that cause the focal stimuli. The residual stimuli can be revealed in the experience a person has had while having a disease in the past.
According to the Roy adaptation theory, health is seen as a part of life. Roy defined this concept as the ability to achieve adaptation to the environment, regardless of the disease. The adaptation theory further explains that the human being must integrate with the environment to be considered whole.
Finally, nursing is the ability to help the four adaptive modes (physiologic, self-concept, role function, and interdependence) to adapt. Nurses need to promote the adaptation of individuals to enable them to achieve a high quality of life or to die with dignity. The author is consistent in defining these concepts because every concept refers to a person and the ability to adapt.
Interpretation of the Definition of Concepts
According to the Roy adaptation theory, the concept of adaptation means that a person can adapt to environmental changes. However, the person needs first to be aware of the environment, then appreciate the need for good health and finally use the resources available in the environment to achieve good health.
Secondly, the concept of a person goes beyond the individual. It refers to every human being in society. The person includes groups, families, and communities. This implies that these people are not only biological aspects, but they also need to think and socialize effectively to achieve good health. Most importantly, people need to use the abilities they were born with or the ones they acquired to interact effectively in their quest for good health.
Thirdly, the environment is not just the immediate surrounding but factors that are beyond the current situation, which affects the health of a person. For instance, considering the three aspects of the environment, the focal stimuli can be the pain, which prompts the patient to seek immediate medical attention. The community can also be affected by diseases such as polio, which need immediate medical attention. Then, the contextual stimuli for a patient are the diseases, which need some time to be treated. For instance, the patients achieve comfort from pain first as the focal stimuli, so that infection as the contextual stimuli can be treated later. Lastly, the residual stimuli go beyond what the patient, family, or community is experiencing. These include circumstances such as having an ailment in the past.
Health is what an individual must possess to achieve good health. Diseases are part of life, and their presence does not mean that people are unhealthy. Therefore, a person only needs to feel all aspects of life being connected to be healthy. Lastly, the nursing concept is seen as a situation when an individual helps others achieve a balance of all the four factors. A nurse is a person who helps other people to coordinate all the factors that lead to good health.
The Relationship among the Major Concepts
Nursing care delivery is holistic. This means that it does not only focus on treating the disease but considers various aspects of the patient that might be contributing to the disease. Callista Roy considered this idea and made sure that all concepts were related. The aspect of a person and adaptation is revealed through the concepts. For instance, adaptation definition mentions individuals, integration, and adaptation. The person concept considers the biological, sociological, and psychological aspects and the way they integrate to adapt. Next, the environment is where an individual adapts. Health is the state of being integrated as a whole to adapt effectively. Lastly, nursing is the ability to help individuals to adapt. Therefore, the concepts are interrelated in helping people to adapt.
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The theory has various assumptions. First, the theory assumes that a person is a bio-psycho-social and spiritual being. Next, the person uses their abilities, innate, or acquired to adapt to the environment (Naga & Al-Atiyyat, 2014). The theory also assumes that health and illness are inevitable. Another assumption is that, for the person to be considered healthy, they must adapt to the environment. Besides, the theory assumes that the four modes of adaptation include self-concept, interdependence, and role function. Finally, the theory suggests that nursing accepts the humanistic approach to appreciating the opinions of other people, thus helping them to adapt.
Adaptation Theory and the Metaparadigm of Nursing
The adaptation theory explains the four concepts of the meta-paradigm of nursing. Callista Roy describes the four concepts in detail. The person is portrayed as a bio-psycho-social being who uses acquired and innate mechanisms to adapt. The environment is composed of three stimuli (focal, contextual, and residual), which when coordinated well, can help a patient to adapt. Health is seen as a combination of all aspects of a person. The health concept in the adaptation theory also explains that illness is part of human life, and its presence does not indicate the disease. Finally, Callista Roy defines nursing as the ability to help a person adapt to various interrelated systems.
Dr. Roy in her theory makes it clear that for a person to be healthy, various factors must be available that should enable the person to adapt. She uses the four well-known meta-paradigms of nursing to clarify her concept. The theory is also logical considering that it begins with the focal stimuli and ends with residual stimuli when explaining the environmental concept. The theory has also been tested and is consistent with other nursing theories. Therefore, the theory is clear and consistent. However, the theory has many concepts that can make it difficult for some nurses to understand.
Nurses associate themselves with patients and families on a daily basis. In the healthcare setting, the nurse has to assess the patient, diagnose an illness, plan interventions, and implement them. Besides, the nurse monitors how the patient is responding to the interventions. The adaptation theory helps nurses not only to carry out their daily responsibilities but also to consider various aspects when caring for the patient. When nurses use this theory, they can be sure that all the needs of the patients are met. Similarly, the community health nurses can use the theory in the community to make sure that all the interrelated systems are harmonized.
Application of the Adaptation Theory in Nursing
The adaptation theory is relevant to my nursing practice in different ways. First, the theory can enable me to examine the patient in various ways. Instead of just looking at the pathophysiology of the diseases, I can collect information about the perceptions and knowledge of the patient regarding the disease. Besides, I can also ensure effective relationships between my patients and their family members. Furthermore, I can use this theory to protect the image of nursing since it portrays a nurse as a sole helper for the patient to adapt. Finally, I can read more about the current research concerning the theory, which can enable me to apply evidence-based practice in my nursing experience.
Theories are necessary for patient care. The adaptation theory by Callista Roy is unique compared to other approaches in that, instead of only focusing on nursing tasks, the theory focuses on the patient holistically. Furthermore, her approach perceives a nurse as a helper. Using this theory, the nurse considers the needs of the patient and integrates them, as well as reprioritizes them during nursing care delivery. However, nurses must realize that not all theories can be applied to patient care. Different theories are better applied to different patients due to the variability in the settings of nursing care. Nevertheless, the adaptation theory by Callista Roy can be applied to many settings and therefore, is significant to the nursing practice.