Martha Rogers

Martha Rogers’s nursing theory, known as the Science of Unitary Human Beings, emphasizes
both the scientific nature of nursing as well as its humanitarian aspects. It is a diverse model
developed in the middle of the previous century, but which retains relevance to this day. Though
not describing specifics, the framework set by Rogers’s theory allows nurses to operate from a
place of scientific assurance in the work they do, all the while maintaining focus on the patients
they work with. Martha Rogers’s theory is a useful model for addressing the growing issue of
nursing burnout, which is known to cause increased rates of morbidity and mortality in the
clinical setting (Alligood, 2014).

The Theory at Different Nursing Levels

When applying the Science of Unitary Human Beings to the individual level, the first thing to
note is Rogers’s maxim to treat each person as irreducible. Though certainly, each human is
made up of systems and tissue which must be understood to save a life or reduce one’s suffering,
Rogers insists that individuals are more than the sum of their parts. Each human being has value
intrinsic to his or herself that cannot be understood through mere knowledge of the workings of
that human’s body (Alligood, 2014).
The mind plays a role in Rogers’s nursing model, and it seems to be part of what she sees as
being the driving force to do good work in the field. Every nurse, much like every doctor, must
reconcile within themselves why they do their work and why it is important to continue.
Rogers’s offers that humans are more complex than the parts nurses interact with when
endeavouring to cure or mend them. Therefore, nurses’ efforts are amplified when they endeavor
to help save a life since that life is more valuable than the body that the nurse helped save. In this
way, a nurse can find strong motivation to do this work to the best degree possible (Alligood,
2014).
That an individual is naturally embedded within their environment, is strongly influential on
Rogers’s belief that nursing must be treated as a science. Nurses inherently are involved with
observations and interventions that affect the world around them. Though each human is a
complete individual unto themselves and is greater than the sum of their parts, these humans fit
into a larger network of people known as a social structure or simple society. Therefore, nursing
must be responsible for the effect it has on the world as a whole.
This observation on Rogers’s part has two implications. One is that an individual’s health is
inherently linked to those around that individual and cannot be entirely understood in a vacuum.
This is a common theme, explored by other nursing theorists as well. More unique is the way
Rogers uses this concept to connect nursing to the sciences, arguing that an individual’s impact
on and influence by their environment makes nursing a naturally scientific field. Koffi & Fawcett
(2016) point out that Rogers’s theories helped spark a new era of scientific thought within the
nursing community.
As has been hinted at so far, Marth Roger’s theory, the Science of Unitary Human Beings, has
had a strong impact on health and nursing. But more clearly, it is important to note that by
emphasizing both an individual's inherent worth as well as how that individual relates to the
environment, Rogers’s helped improve patient centered nursing practice. Under Rogers’s model,
the concept of health expands beyond the body to the mind and, even more impressively, the
relationships a patient has. This allows nurses to assess patients based on their psychosocial
functioning in the world (Alligood, 2014).

Addressing Problems in Nursing

Rogers’s model is useful for addressing the issue of nursing burnout. Nursing staff burnout is one
of the main obstacles to effectively maintaining a culture of safety, which is a set of “shared
values, beliefs, norms, and procedures related to patient safety among members of an
organization” (Weaver et al., 2013). Many nurses, while supporting in safety culture, end up
compromising it due to being overworked. Some nurses, for example, work two full time jobs at
separate facilities, which leads to exhaustion.
The more stressed and tires a nurse becomes, the more likely mistakes are. Burnout is condition
that occurs when stress becomes so bad that it creates a kind of malaise. Though a nurse may
know that focus is important for the job, one experiencing burnout simply cannot find the
motivation to keep focus. Nurse burnout adds to anxiety and at risk behavior in workplace and
poor patient nurse communication. Nursing burnout may lead to poor decision making, example
cohorting delirious patient with frail elderly (Dall'ora, C., Griffiths, & Ball, 2015).
Rogers’s approach to nursing frames the work in a new light. While many nurses have strong
motivating factors when entering the field, seeing the results of what they do as being greater
than the sum of their parts and having a rippling effect out in the environment can help them
remained focused even during mental fatigue. Furthermore, applying Rogers’s theory to nurses
themselves can help management see the need to allow nurses to rest. There is no wisdom in
having an overworked staff. Since Rogers promotes understanding the connection of a patient to
the environment, and application of her theory in this context would allow administrators to see
that nursing staff are in fact a part of a patient’s environment. If the staff are not healthy, neither
will the patients be (Dall'ora, C., Griffiths, & Ball, 2015).
Rogers’s theory works well with another model laid out by Betty Neuman, which focuses on the
response of patients to environmental stressors. Since, as was just discussed, nurses themselves
are a part of a patient’s environment, nurses who are burned out will act as a stressor to patients.
Though the patient may not perceive this stress consciously, a nurse’s action’s can have great
impact on a patient’s health. Furthermore, nurses who are burned out are more likely to create
situations that are stressful for a patient. Nurses are often responsible for patient placement
within a clinic, and the loss of focus inherent to burnout could cause them to make poor choices
when choosing which environments would be best suited to which patients (Ahmadi & Sadeghi,
2017).

Analysis and Comparison

Both models, Rogers’s Science of Unitary Human Beings and Neuman’s model addressing
patient stressors, would work well for addressing nursing burnout and creating a culture of safety.
One model stands out from the other, however, for being useful as both a motivational tool and a
practical method of approaching the workplace environment of nurses: Rogers’s model.
As was mentioned, Rogers’s theory can be a source of motivation for nurses facing burnout,
allowing them to see the importance of their work in a greater scope. But it is also a model that
can be applied to nurses themselves and which dictates that nurses are inherently linked in health
to those around them. If the nurse is unhealthy, so too will be the patient. Neuman’s model on
the other hand provides very good motivation for why patients must be kept in a stress free
environment, but does little to show how this might be done. Essentially, when applied to the
specific topic of nursing burnout, Neuman’s model says little more than what is already known:
that burnout can be harmful and that patients must be protected from the potential stressors
nurses may cause them (Alligood, 2014).
As Weaver et al. (2013) demonstrates, creating a culture of safety within the health care setting is
something that must be addressed scientifically. Rather than merely hoping everyone has the
same goals in mind, there is an actual method to ensuring people are coordinating and
communicating properly to create a safe environment in which healing can occur. Rogers’s
theory beats Neuman’s in this arena as well. Though Neuman’s model is not at all against
science, it does not offer any answers in this area. Rogers’s theory is meant to be scientific and
encourages an empirical approach to addressing all problems that may arise when applying this
theory. Simply put, it is more likely to help create an evidence based practice for creature a
culture of safety.

Conclusion
The work of Martha Rogers has been an important contribution to the nursing community both
for its reframing of the scope of the work being done and for its emphasis on scientific processes
needed to address the problems facing nursing. It emphasizes both the importance of the
individual as well as the connections that individual has to the environment and society as a
whole. It presents human beings as being more than the sum of their whole. At the same time,
Rogers’s theory advocates for an empirical approach to the problems facing nursing. Rogers’s
work can be supplemented by Neuman’s when addressing nursing burnout. This creates a clear
chain of action that must be accomplished to maintain a culture of safety that starts with
identifying nurses as a part of the clinical environment and ends with reducing stressors to
patients that would result from nursing burnout.

References
Alligood, M. R. (2014). Nursing Theory: Utilization & Application. St. Louis, MO: Elsevier.
Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the
nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal – Experimental,
Translational and Clinical, 3(3), 205. doi:10.1177/2055217317726798
Dall'ora, C., Griffiths, P. & Ball, J. (2015) 12 hour shifts: nurse burnout, job satisfaction &
intention to leave Evidence Brief, (3), 1-2.
Koffi, K. & Fawcett, J. (2016). The two nursing disciplinary scientific revolutions: Florence
Nightingale and Martha E. Rogers. Nursing Science Quarterly, 29(3).
Weaver, S. J., Lubomksi, L. H., Wilson, R. F., Pfoh, E. R., Martinez, K. A., & Dy, S. M. (2013).
Promoting a culture of safety as a patient safety strategy: A systematic review. Annals of Internal
Medicine, 158(5 0 2), 369–374. http://doi.org/10.7326/0003-4819-158-5-201303051-00002

In 1976, Sister Callista Roy developed the Adaptation Model of Nursing, a prominent nursing
theory. Nursing theories frame, explain or define the practice of nursing. Roy's model sees the
individual as a set of interrelated systems (biological, psychological and social). The individual
strives to maintain a balance between these systems and the outside world, but there is no
absolute level of balance. Individuals strive to live within a unique band in which he or she can
cope adequately.

Overview of the theory

This model comprises the four domain concepts of person, health, environment, and nursing; it
also involves a six-step nursing process. Andrews & Roy (1991) state that the person can be a
representation of an individual or a group of individuals.[1] Roy's model sees the person as "a
biopsychosocial being in constant interaction with a changing environment".[2] The person is an
open, adaptive system who uses coping skills to deal with stressors. Roy sees the environment as
"all conditions, circumstances and influences that surround and affect the development and
behaviour of the person".[1] Roy describes stressors as stimuli and uses the term residual
stimuli to describe those stressors whose influence on the person is not clear.[1] Originally, Roy
wrote that health and illness are on a continuum with many different states or degrees
possible.[2] More recently, she states that health is the process of being and becoming an
integrated and whole person.[1] Roy's goal for nursing is "the promotion of adaptation in each of
the four modes, thereby contributing to the person's health, quality of life and dying with
dignity".[1] These four modes are physiological, self-concept, role function and interdependence.
Roy employs a six-step nursing process: assessment of behaviour; assessment of stimuli; nursing
diagnosis; goal setting; intervention and evaluation. In the first step, the person's behaviour in
each of the four modes is observed. This behaviour is compared with norms and is deemed either
adaptive or ineffective. The second step is concerned with factors that influence behaviour.
Stimuli are classified as focal, contextual or residual.[2] The nursing diagnosis is the statement of
the ineffective behaviours along with the identification of the probable cause. This is typically
stated as the nursing problem related to the focal stimuli, forming a direct relationship. In the
fourth step, goal setting is the focus. Goals need to be realistic and attainable and are set in
collaboration with the person.[1] There are usually both short term and long term goals that the
nurse sets for the patient. Intervention occurs as the fifth step, and this is when the stimuli are
manipulated. It is also called the 'doing phase' .[2]In the final stage, evaluation takes place. The
degree of change as evidenced by change in behaviour, is determined. Ineffective behaviours
would be reassessed, and the interventions would be revised.[1]
The model had its inception in 1964 when Roy was a graduate student. She was challenged by
nursing faculty member Dorothy E. Johnson to develop a conceptual model for nursing practice.
Roy’s model drew heavily on the work of Harry Helson, a physiologic psychologist. [3] The Roy
adaptation model is generally considered a "systems" model; however, it also includes elements
of an "interactional" model. The model was developed specifically for the individual client, but it
can be adapted to families and to communities (Roy, 1983)[full citation needed]. Roy states (Clements
and Roberts, 1983)[full citation needed] that "just as the person as an adaptive system has input, output.
and internal processes so too the family can be described from this perspective."
Basic to Roy’s model are three concepts: the human being, adaptation, and nursing. The human
being is viewed as a biopsychosocial being who is continually interacting with the environment.
The human being’s goal through this interaction is adaptation. According to Roy and Roberts
(1981, p. 43)[full citation needed], ‘The person has two major internal processing subsystems, the
regulator and the cognator." These subsystems are the mechanisms used by human beings to
cope with stimuli from the internal and external environment. The regulator mechanism works
primarily through the autonomic nervous system and includes endocrine, neural, and perception
pathways. This mechanism prepares the individual for coping with environmental stimuli. The
cognator mechanism includes emotions, perceptual/information processing, learning, and
judgment. The process of perception bridges the two mechanisms (Roy and Roberts, 1981)[full
citation needed]
.

Types of Stimuli

 Three types of stimuli influence an individual’s ability to cope with the environment. These
indude focal stimuli, contextual stimuli, and residual stimuli. Focal stimuli are those that
immediately confront the individual in a particular situation. Focal stimuli for a family
include individual needs; the level of family adaptation; and changes within the family
members, among the members and in the family environment (Roy, 1983)[full citation needed].
Contextual stimuli are those other stimuli that influence the situation. Residual stimuli
include the individual’s beliefs or attitudes that may influence the situation. Many times this
is the nurse's "hunch" about other factors that can affect the problem. Contextual and residual
stimuli for a family system include nurturance, socialization, and support (Roy, 1983).
Adaptation occurs when the total stimuli fall within the individual’s/family’s adaptive
capacity, or zone of adaptation. The inputs for a family include all of the stimuli that affect
the family as a group. The outputs of the family system are three basic goals: survival,
continuity, and growth (Roy, 1983)[full citation needed]. Roy states (Clements and Roberts,
1983)[full citation needed]:
 Since adaptation level results from the pooled effect of all other relevant stimuli, the nurse
examines the contextual and residual stimuli associated with the focal stimulus to ascertain
the zone within which positive family coping can take place and to predict when the given
stimulus is outside that zone and will require nursing intervention.

Four Modes of Adaptation[edit]

Levine believes that an individual’s adaptation occurs in four different modes. This also holds
true for families (Hanson, 1984). These include the physiologic mode, the self-concept mode, the
role function mode, and the interdependence mode.[3]
The individual’s regulator mechanism is involved primarily with the physiologic mode, whereas
the cognator mechanism is involved in all four modes (Roy and Roberts, 1981)[full citation needed].
The family goals correspond to the model’s modes of adaptation: survival = physiologic mode;
growth = self-concept mode; continuity = role function mode. Transactional patterns fall into the
interdependence mode (Clements and Roberts, 1983)[full citation needed].
In the physiologic mode, adaptation involves the maintenance of physical integrity. Basic human
needs such as nutrition, oxygen, fluids, and temperature regulation are identified with this mode
(Fawcett, 1984)[full citation needed]. In assessing a family, the nurse would ask how the family
provides for the physical and survival needs of the family members. A function of the self-
concept mode is the need for maintenance of psychic integrity. Perceptions of one’s physical and
personal self are included in this mode. Families also have concepts of themselves as a family
unit. Assessment of the family in this mode would include the amount of understanding provided
to the family members, the solidarity of the family, the values of the family, the amount of
companionship provided to the members, and the orientation (present or future) of the family
(Hanson, 1984)[full citation needed].
The need for social integrity is emphasized in the role function mode. When human beings adapt
to various role changes that occur throughout a lifetime, they are adapting in this mode.
According to Hanson (1984)[full citation needed], the family’s role can be assessed by observing the
communication patterns in the family. Assessment should include how decisions are reached, the
roles and communication patterns of the members, how role changes are tolerated, and the
effectiveness of communication (Hanson, 1984)[full citation needed]. For example, when a couple
adjusts their lifestyle appropriately following retirement from full-time employment, they are
adapting in this mode.
The need for social integrity is also emphasized in the interdependence mode. Interdependence
involves maintaining a balance between independence and dependence in one’s relationships
with others. Dependent behaviors include affection seeking, help seeking, and attention seeking.
Independent behaviors include mastery of obstacles and initiative taking. According to Hanson
(1984), when assessing this mode in families, the nurse tries to determine how successfully the
family lives within a given community. The nurse would assess the interactions of the family
with the neighbors and other community groups, the support systems of the family, and the
significant others (Hanson, 1984)[full citation needed].
The goal of nursing is to promote adaptation of the client during both health and illness in all
four of the modes. Actions of the nurse begin with the assessment process, The family is
assessed on two levels. First, the nurse makes a judgment with regard to the presence or absence
of maladaptation. Then, the nurse focuses the assessment on the stimuli influencing the family’s
maladaptive behaviors. The nurse may need to manipulate the environment, an element or
elements of the client system, or both in order to promote adaptation.[3]
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.

Applying Roy’s Model to Family Assessment[edit]

When using Roy’s model as a theoretical framework, the following can serve as a guide for the
assessment of families.

 I. Adaptation Modes
 A. Physiologic Mode
 1. To what extent is the family able to meet the basic survival needs of its members?
 2. Are any family members having difficulty meeting basic survival needs?
 B. Self-Concept Mode
 1. How does the family view itself in terms of its ability to meet its goals and to
assist its members to achieve their goals? To what extent do they see themselves as
self-directed? Other directed?
 2. What are the values of the family?
 3. Describe the degree of companionship and understanding given to the family
members
 C. Role Function Mode
 1. Describe the roles assumed by the family members.
 2. To what extent are the family roles supportive, in conflict, reflective of role
overload?
 3. How are family decisions reached?
 D. Interdependence Mode
 1. To what extent are family members and subsystems within the family allowed to
be independent in goal identification and achievement (e.g., adolescents)?
 2. To what extent are the members supportive of one another?
 3. What are the family’s support systems? Significant others?
 4. To what extent is the family open to information and assistance from outside the
family unit? Willing to assist other families outside the family unit?
 5. Describe the interaction patterns of the family In the community.
 II. Adaptive Mechanisms
 A. Regulator: Physical status of the family in terms of health? i.e., nutritional state,
physical strength, availability of physical resources
 B. Cognator: Educational level, knowledge base of family, source of decision making,
power base, degree of openness in the system to input, ability to process
 III. Stimuli
 A. Focal
 1. What are the major concerns of the family at this time?
 2. What are the major concerns of the individual members?
 3. This is usually related to the nursing diagnoses or the main stimuli causing the
problem behaviors. It is important for the nurse to try to fix this before they can fix
the problem behaviors as they are related to each other.[4]
 B. Contextual
 1. What elements in the family structure, dynamic, and environment are impinging
on the manner and degree to which the family can cope with and adapt to their major
concerns (i.e., financial and physical resources, presence or absence of support
systems, clinical setting and so on)?
  These can be either negative or positive as it relates to the main nursing problem.
 C. Residual
 1. What knowledge, skills, beliefs, and values of this family must be considered as
the family attempts to adapt (i.e., stage of development, cultural background,
spiritual/religious beliefs, goals, expectations)? This is normally an assumption that
the nurse has that could impact care. One could describe it as one's educational guess
about something going on in the patient's life that could be further contributing to the
problem.[5]
The nurse assesses the degree to which the family’s actions in each mode are leading to positive
coping and adaptation to the focal stimuli. If coping and adaptation are not health promoting,
assessment of the types of stimuli and the effectiveness of the regulators provides the basis for
the design of nursing interventions to promote adaptation.
By answering each of these questions in each assessment, a nurse can have a full understanding
of the problem's a patient may be having. It is important to recognize each stimuli because
without it, not every aspect of the person's problem can be confronted and fixed. As a nurse, it is
their job to recognize all of these modes, mechanisms, and stimuli while taking care of a patient.
They do so through the use of their advanced knowledge of the nursing process as well as with
interviews with the individuals and the family members.
Callista Roy maintains there are four main adaptation systems, which she calls modes of
adaptation. She calls these the 1. the physiological - physical system 2. the self-concept group
identity system 3. the role mastery/function system 4. the interdependency system.

Reference

1. ^ Jump up to:a b c d e f g Andrews & Roy 1991.

2. ^ Jump up to:a b c d Rambo 1984.
3. ^ Jump up to:a b c Roy 1980.
4. Jump up^ Roy, Callista (2009). The Roy Adaptation Model. Pearson. p. 24. ISBN 978-
0130384973.
5. Jump up^ Roy, Callista (2009). The Roy Adaptation Model. Prentice Hall.
p. 23. ISBN 978-0130384973.

 Khajehgoodari, Mohammad; Sima Lakdizaji; Hadi Hassankhni; Alireza Mohajjel Agdam;

Mohammad Khajegodary; Rezvanieh Salehi (March 2013). "Effect of Educational Program
on Quality of Life of Patients with Heart Failure: A Randomized Clinical Trial". Journal of
Caring Sciences. 2 (1): 11–18. doi:10.5681/jcs.2013.002.