Adaptation model of nursing
The Adaptation Model of Nursing, developed by Callista Roy in 1976, revolutionizes the role of nurses in patient care by emphasizing the importance of individualized approaches to treatment. This model posits that patients are complex individuals who respond to illness on multiple levels—physical, mental, emotional, and spiritual—rather than being mere recipients of standardized medical protocols. Roy's framework encourages nurses to engage deeply with patients, recognizing their unique experiences and involving them in their recovery process.
Central to the model are two core assumptions: health and illness exist on a continuum, and nurses treat people, not just medical conditions. The model outlines a systematic approach where nurses observe patient behavior, assess stimuli, set achievable goals, implement interventions, and continuously evaluate outcomes. Roy's pioneering work highlights the significant impact of compassionate care and interpersonal communication, demonstrating that patients can adapt to their health challenges when treated with dignity and respect. This model has been successfully applied across various nursing fields, underscoring its relevance in fostering holistic patient care.
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Adaptation model of nursing
The Roy Adaptation Model, also called the adaptation model of nursing, was first published by pioneering nursing theoretician Callista Roy (b. 1939) in 1976. Roy’s model radically redefined the role of the nurse in treatment protocols. At the core of the adaptation model is how medical professionals such as nurses can best approach the interaction with a patient. Before Roy, the assumption was that the best approach was to treat each patient like someone who was sick and whose recovery protocol had been outlined and provided by the attending physician. The recovery protocol for one patient was for the most part the same as the recovery regimen for any patient dealing with a similar illness. Standardizing the approach to a patient guaranteed a common core of practices that minimized the role of the nurse. Roy’s theoretical premise, that a patient is a complex individual who responds to the challenge of illness on multiple levels, has become a widespread model for nursing practice. Her model has since been applied successfully to virtually all nursing fields, most notably in pediatric care, oncology treatment, long-term cardiac care, and hospice care.
Background
Callista Roy aspired to be a nurse from an early age. She credits her mother, who was a licensed vocational nurse, with inspiring her. As a teenager she volunteered at a large general hospital, where she perceived that nurses did far more than the traditional job description indicated, and were responsible as daily hands-on caregivers for doing more than following hospital procedurals and carrying out physician’s directives. Although certainly they did both, Roy saw that nurses were far more engaged in the recovery regimen of patients and were part of how each individual patient came to understand the reality and the implications of their individual illness.
After high school, Roy entered the Sisters of Saint Joseph of Carondelet, a ministry order that had been involved with providing care assistance in various medical facilities for more than a century. She received her bachelor’s degree in nursing in 1963 from Mount Saint Mary’s College in Los Angeles. After completing her master’s degree in pediatric nursing at the University of California, Los Angeles (UCLA), in 1966, Roy decided to expand her nursing expertise by pursuing first a master’s (1973) and then completing her doctorate (1977) not in nursing but rather in sociology, all at UCLA. Roy perceived that sociology, with its emphasis on how the individual was defined by the interaction with larger communities and how larger community interaction provided both physical and emotional sustenance to the individual, was crucial to understanding the exact nature of how patients cope with illness, which Roy saw as the very heart of the mission of a nurse.
Roy Adaptation Model Today
It is a measure of the groundbreaking nature of Roy’s work that her conceptual model began when a professor in one of her graduate classes at UCLA assigned her students to come up with an actual model that would reflect the day-to-day responsibilities of a nurse. No such model even existed.
Roy’s conceptual model began with two fundamental assumptions: first, health and illness were part of the same continuum. As Roy reasoned, a person did not "get" sick—for Roy that implied helplessness and vulnerability that was not in keeping with her vision of nurse and patient together combating illness. Rather, sickness was better approached as a movement away from health, movement that the nurse and patient together could reverse. Second, nurses did not treat a patient; rather, nurses treated a person. For Roy, each person admitted as an inpatient was a complicated, cooperative system comprising physical, mental, emotional, and spiritual levels of response or adaptation, and was thus potentially quite different from the person in the bed next to them. In adapting to the reality of illness, each patient drew on all four of those levels. Roy then concluded that a nurse, to be both effective and compassionate, needed to design a response program to each individual patient that in turn recognized these different levels of adaptation and how they worked in conjunction with the other levels. Effective nursing treatment demanded that the nurse recognize the vital role of the patient’s self-concept as well as their perception of the family, friends, and the divine.
In short, Roy was instrumental in introducing the human factor into nursing. Roy theorized that the appropriate goal of a nurse was to assist the patient in adapting to the onset of illness and its inevitable impact. In gathering data on patient care for more than three decades, Roy showed that patients responded positively to encouragement, clear direction, honesty, and interpersonal communication, and in turn demonstrated a remarkable capacity to change, adapting to the reality of illness if they were treated with dignity and compassion. The nurse then provided direct and clear stimuli daily.
Roy’s model, as it evolved, came to endorse six levels of response for nurses that collectively provided patients with integrated care. First, the nurse observes patient behavior, creating a patient profile grounded in measureable data; second, the nurse observes the patient’s stimuli, and rejects what does not work for the patient; third, the nurse, in close communication with the attending physicians, creates a patient profile that diagnoses why such protocols proved ineffective; fourth, the nurse sets reasonable, achievable goals for charting the patient’s adaptation to the illness; fifth, the nurse applies the actual interventions, and works with the patient to direct the patient’s adaptation program to meet those goals; and sixth, the nurse must constantly evaluate the success of the designated protocols as a way to direct short-term and long-term recovery.
Bibliography
Akinsanya, Justus A. The Roy Adaptation Model in Action. London: Macmillan, 1994. Print.
Alligood, Martha Raile. Nursing Theory: Utilization and Adaptation. 5th ed. St. Louis: Elsevier, 2014. Print.
Alligood, Martha Raile, and Ann Marriner-Tomey. Nursing Theorists and Their Work. 8th ed. St. Louis: Elsevier, 2014.
Boston Based Adaptation Research in Nursing Society. Roy Adaptation Model-Based Research: A 25 Years of Contributions to Nursing Science. Indianapolis: Sigma Theta Tau, 1999. Print.
Roy, Callista. The Roy Adaptation Model. 3rd ed. Upper Saddle River: Pearson, 2009. Print.
Sitzman, Kathleen, and Lisa Wright Eichelberger. Understanding the Work of Nursing Theorists: A Creative Beginning. 3rd ed. Burlington: Jones, 2017. Digital file.
"Sr. Callista Roy, PhD, RN, FAAN." Boston College: William F. Connell School of Nursing. Trustees of Boston College, 20 July 2016. Web. 12 Sept. 2016.