ROYS ADAPTATION MODEL

INTRODUCTION

“The changing environment stimulates the person to make adaptive responses. For human
beings, life is never the same. It is constantly changing and presenting new challenges. The
person has the ability to make new responses to these changing conditions. As the environment
changes, the person has the opportunity to continue to grow, to develop and to enhance the
meaning of life for everyone.
(Andrews H.A & Roy Sr. C.)
Human beings are incessantly besieged by a host of internal and external environmental
stimuli. A stimulus is an entity that provokes a response and that serve as the point of
interaction between the person and the environment. Environment stimuli either threaten or
enhance the individual’s ability to adapt.
Nursing plays a vital role in assisting individuals who are sick or well to respond to a variety
of new stressors, move toward optimal well being, and improve the quality of their lives
through adaptation. The Roy Adaptation Model provides an effective framework for
addressing the adaptive needs of individual, family and groups. Nursing’s most pressing
question is;
“What is the nature of knowledge that is needed for the practice of nursing?”
 Nurses practicing within the Roy Adaptation Model seek the following:
 Greater knowledge of factors that either promote or hinder adaptation.
 Better methods and tools for assessing adaptation level.
 Specific nursing interventions that either promote or hinder adaptation.
 Effective methods for evaluating adaptation as an outcome of nursing care.

HISTORY AND BACKGOUND

S. Callista Roy, a sister of Saint Joseph of Carondelet, developed the Roy Adaptation Model
(RAM) in 1964 in response to a challenge by her professor, Dorothy E. Johnson. Since that
time RAM has been reconceptualized for use in the 21 st century. The development of the model
has been a dynamic process. The preliminary ideas of this conceptual framework were first
published in an article entitled “Adaptation: A Conceptual Framework for Nursing” (Roy,
1970). The RAM continues to be refined. The RAM is presented in its most complete and
recent form in the Roy Adaptation Model (Roy & Andrews, 1999). Many nurses in the United
States, Canada and worldwide practice nursing from the perspective of the RAM. The RAM
has been implemented in numerous hospitals and other health care settings.

ELEMENTS OF THE ROY ADAPTATION MODEL

There are five essential elements of the RAM. They are;

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

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THE PERSON
The first area of concern is the identity of the recipient of nursing care. Roy states that
the recipient of nursing care may be the person, a family, a group, a community, or a society.
Each is considered by the nurse as a holistic adaptive system. The idea of an adaptive system
combines the concepts of adaptation and system.
First, consider the concept of a system as applied to an individual. Roy conceptualizes the
person in a holistic perspective. Individual aspects of parts act together to form a unified being.
Additionally, persons, as living systems, are in constant interactions with their environments.
Between the system and the environment occurs an exchange of information, matter, and
energy. This characteristic of a living system is called openness.
The constant interaction of persons with their environment is characterized by both
internal and external changes. Within this changing world persons must maintain their own
integrity; that is, each person continuously adapts. Hence, the person is viewed as a holistic
adaptive system.

Input Processes Effectors Output

Physiological
Coping function Adaptive
Stimuli mechanisms Self-Concept and
Adaptation Regulator Role Function Ineffective
level Cognator Interdependence responses

Feedback

The person as an adaptive system

Adaptive system of a person

1. INPUT- Input coming from the external environment as well as input coming
internally from the person. Roy identifies inputs as stimuli. Along with the stimuli, the
adaptation level of the person acts as input to that person as an adaptive system. The
adaptation level is the range of stimuli to which the person can adaptively respond with
ordinary effort. This range of response is unique to the individual. Each person’s adaptation
level is constantly changing aspect which is influenced by the coping mechanisms of that
person. Roy uses Helson’s work to develop this construct.

2. OUTPUT- Outputs of the person as a system are the behaviors of the person. Output
behaviors can be both external and internal. Thus, these behaviors may be observed,
measured, or subjectively reported. Output behaviors become feedback to the system. Roy

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 has categorized outputs of the system as either adaptive responses or ineffective responses.
Adaptive responses are those that promote the integrity of the person. The person’s
integrity or wholeness is behaviorally demonstrated when the person is able to meet the
goals in terms of survival, growth, reproduction and mastery. Ineffective responses do not
support these goals.

3. CONTROL PROCESSES- Roy has used the term coping mechanisms to describe the
control processes of the person as an adaptive system. Some coping mechanisms are
inherited or genetic. Other mechanisms are learned. Roy presents a unique nursing science
concept of control mechanisms. These mechanisms are called the regulator and the
cognator. Roy’s model considers the regulator and cognator coping mechanisms as
subsystems of the person as an adaptive system.
 Regulator subsystem- The regulator subsystem has the system of components of input,
internal process, and output. Input stimuli may originate externally or internally to the
person. The transmitters of the regulator system are chemical, neural or endocrine in
nature. Autonomic reflexes, which are neural responses originating in the brain stem and
spinal cord, are generated as output behaviors of the regulator subsystem. Target organs
and tissues under endocrine control also produce regulator output behaviors. Finally, Roy
presents psychomotor responses originating from the central nervous system as regulator
subsystem behaviors. Many physiological processes can be viewed as regulator subsystem
behaviors.

Internal Neural Spinal cord; Effectors Automatic

stimuli brainstem & reflex
Chemical autonomic response
reflexes

Intact Intact Response Hormonal Response Body

Circulation Pathways of endocrine output of target response
to & from glands organs
CNS
Chemical

External
stimuli
Neural Perception Short term Psycho- Effectors
memory motor
choice of
response

Long term memory

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 Cognator subsystem- The other control subsystem original to the Roy model is the
cognator subsystem. Stimuli to the cognator subsystem are also both external and internal in
origin. Output behavior of the regulator subsystem can be feedback stimuli to the cognator
subsystem. Cognator control processes are related to the higher brain functions of perception or
information processing, judgment, and emotion. Perception or information processing is related
to the internal process of selective attention, coding, and memory. Learning is correlated to the
processes of imitation, reinforcement, and insight. Problem solving and decision making are
the internal processes related to judgment; and finally, emotion has the processes of defense to
seek relief, affective appraisal and attachment.
In maintaining the integrity of the person, the regulator and cognator are postulated as
frequently acting together. The adaptation level of the person as an adaptive system is
influenced by the individual’s development and use of these coping mechanisms. Maximal use
of coping mechanisms broadens the adaptation level of the person and increases the range of
stimuli to which the person can positively respond.
Roy does not limit the concept of control processes to the regulator and cognator subsystems.
She identifies the development of these concepts as a step towards greater understanding of
human behavior. Hence, knowledge of control processes of the person as an adaptive system is
open to research and development.

Internal
stimuli
Intact pathways
and apparatus for Processes for

Perception Selective attention,

coding, and memory

Learning Imitation, reinforcement,

and insight
Psycho- Effectors Response
Judgment Problem-solving and motor
decision-making response

Emotion Defenses to seek relief

and affective appraisal
and attachment
External
stimuli

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4. EFFECTORS- The four effectors or adaptive modes are;
 Physiological function
 Self-concept
 Role function
 Interdependence
The regulator and cognator mechanisms are viewed as acting within these modes. Behavior
related to the modes is the manifestation of the person’s adaptive level and reflects the use of
coping mechanisms. By observing the person’s behavior in relation to the adaptive modes, the
nurse can identify adaptive or ineffective responses in situations of health and illness.

PHYSIOLOGICAL FUNCTION MODE

It involves the body’s basic physiological needs and ways of adapting these.
 Oxygenation – Describes the pattern of oxygen use related to respiration and circulation.
 Nutrition – Describes patterns of nutrient use for body repair and development.
 Elimination – Describes patterns of elimination of waste products.
 Activity and rest – Describes patterns of exercise, activity, rest and sleep.
 Skin Integrity – Describes patterns of the physiological function of the skin.
 Senses – Describes the sensory-perceptual functions related to obtaining visual, auditory,
kinesthetic, gustatory, tactile, and olfactory information.
 Fluids and Electrolytes – Describes patterns of physiological use of fluids and
electrolytes.
 Neurological function – Describes the neural patterns of control, regulation, and intellect.
 Endocrine function – Describes patterns of control and regulation including the stress
response and the reproduction system.

SELF CONCEPT MODE

The self concept mode identifies patterns of values, beliefs and emotions as related to
one’s idea of self. Attention is given to the realm of physical self, personal self, and moral-
ethical self.

ROLE FUNCTION MODE

The role function mode identifies the patterns of social interaction of the person in
relation to others reflected by primary, secondary and tertiary roles. Selected areas of focus
include the process of role identity and role mastery.

INTERDEPENDENCE MODE
The interdependence mode identifies patterns of human value, affection, love, and
affirmation. These processes occur through interpersonal relationships on both individual and
group levels.

These four modes are the channels through which the person adapts to internal and
external changes. Response to change by the person may be processed predominately in a
single adaptive mode. More often, the response is processed simultaneously in more than one
mode.

GOAL OF NURSING

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 Roy defines the goal of nursing as the promotion of adaptive responses in relation to the
four adaptive modes. Adaptive responses are those that positively affect health. Helson’s work
is cited by Roy as useful in understanding the concept of adaptation in relation to the holistic
qualities of the person. Helson views the person’s adaptation to change as dependent upon the
stimuli that are input for the person and the person’s adaptation level.
Internal and external changes, that is, input stimuli, interface with the person’s state of
coping, the other significant element in the adaptation process. The condition of the person or
the individual’s state of coping is that person’s adaptation level. The person’s adaptation level
is determined by focal, contextual, and residual stimuli.
Focal stimuli – The stimuli immediately confronting the person are the focal stimuli. The focal
stimuli normally constitute the greatest degree of change impacting upon the person.
Contextual stimuli – These are all other stimuli of the person’s internal and external world
that influence the situation and are observable, measurable or subjectively reported by the
person.
Residual stimuli – These stimuli are those make-up characteristics of the person that are
present and relevant to the situation but are elusive or difficult to measure objectively.

S
Adaptation level = +R or Adaptation

Adaptation level = -R or Ineffective

response

Adaptation level

The degree of change facing the person is equated to the focal stimulus. If the person’s
adaptation level is viewed as a line, the zone of adaptation is the distance above and below that
line that sets the limit of the person’s adaptation capacity. When the total stimuli fall within the
person’s zone of adaptation, an adaptive response or output results. However when the total
stimuli fall outside the individual’s zone of adaptation, ineffective output behavior or responses
occur. Nursing seeks to reduce ineffective responses and promote adaptive responses as output
behavior of the person. A person’s ability to cope varies with the state of the person at different
times.

NURSING ACTIVITIES
Nursing activities are those that promote adaptive responses in situations of health and
illness. As a rule, these approaches are identified as actions taken by the nurse to manipulate
the focal, contextual, and residual stimuli impinging on the person. By making these
adjustments, the total stimuli fall within the adaptive zone of the person. Whenever possible,
the focal stimulus, that which represents the greatest degree of change, is manipulated. When

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focal stimuli cannot be altered, the nurse promotes an adaptive response by manipulating
contextual and residual stimuli.
Additionally, the nurse may anticipate that the person has a potential for ineffective
responses secondary to stimuli likely to be present in a particular situation. The nurse acts to
prepare the person for the anticipated changes through strengthening regulator, cognator, or
other coping mechanisms. Plans that broaden the person’s adaptation level correlate with the
ideas of health promotion currently found in the literature. Finally, nursing actions suggested
by the model include approaches aimed at maintaining adaptive responses thus supporting the
person’s efforts to creatively use his or her coping mechanisms.

HEALTH
Previously, the Roy model defined health as a continuum from death to high-level
wellness. This is no longer used in the present model. Roy presently defines health as “a state
and a 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, and
mastery. The nurse using Roy’s model uses the concept of health as the goal point for the
person’s behavior. When a disproportionate amount of the person’s energy is used in coping,
less energy is available to meet the goals of survival, growth, reproduction, and mastery.
Nursing aims to promote the health of the person by promoting adaptive responses. Energy
freed from ineffective behavior becomes available for promotion of health.

ENVIRONMENT
Stimuli from within the person and stimuli from around the person represent the element
of environment according to Roy. Environment is specifically defined by Roy as “all
conditions, circumstances, and influences surrounding and affecting the development and
behavior of persons and groups.”
Commonly occurring internal and external stimuli of the environment are an area of study
for nursing. For example, when an elderly client is institutionalized, significant external
environmental stimuli have impinged upon him or her. The study of environmental condition
aids nurses in promoting adaptation to this change or perhaps more ideally, defining
interventions that minimize the risk of institutionalization for the elderly. Similarly, nurses are
increasing their involvement in the institutions of our nations: health, education, industry, and
politics. By their involvement, they are altering the environmental stimuli related to situations
of health and illness in a broad and often far-reaching manner at a community system level.

THE NURSING PROCESS

Roy adaptation model offers guidelines to the nurse in developing the nursing process. The
elements of Roy nursing process include;
 First level assessment
 Second level assessment
 Diagnosis
 Goal setting
 Intervention
 Evaluation
If first and second level assessments are considered subparts of the same element, the five
elements of Roy’s nursing process parallel the five phases of the nursing process.

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FIRST LEVEL ASSESSMENT
First level assessment considered the gathering of output behaviors pf the person as an
adaptive system in relation to each of the four adaptive modes. First level assessment is
referred to as behavioral assessment.
Assessment of client in each of the four adaptive modes enhances a systematic and holistic
approach. Such assessment clarifies the focus that the nurse or nursing team will take in caring
for the client. Ideally, thoroughly conducted and recorded nursing assessment in the four
adaptive modes sets the tone of understanding the particular situation of a client for an entire
health care team.

SECOND LEVEL ASSESSMENT

After a first level assessment, the nurse analyzes the emerging themes and patterns of
client behavior to identify ineffective responses or adaptive responses requiring nurse support.
When ineffective behaviors or adaptive behaviors requiring support are present, the nurse
conducts a second level assessment. In this phase of assessment, the nurse collects data about
the focal, contextual, and residual stimuli impacting on the client. This process clarifies the
etiology of the problem and identifies significant contextual and residual factors. Martinez
identified “genetic make-up, sex, developmental stage, drugs, alcohol, tobacco, self-concept,
role functions, interdependence, social interaction patterns, coping mechanisms and styles,
physical and emotional stress, cultural orientation, religion, and physical environment” as
contextual stimuli which influence the adaptive modes.
The science of this decision-making process is still in the developmental phase for nursing.
Often additional theories, laws and principles of the arts and science are used to validate the
presence of an adaptation problem. Adaptation problems are indicated when the survival,
growth, reproduction and mastery goals of the person are impeded or when the integrity of the
person is threatened. Further validation may be gained by reviewing the defining
characteristics and etiologies related to nursing diagnosis developed by the North American
Nursing Diagnosis Association (NANDA).

NURSING DIAGNOSIS
Roy describes three methods of making nursing diagnosis.
 One method is to use a typology of diagnoses developed by Roy and related to the four
adaptive modes.

Working typology of common adaptation problems

A. Physiologic mode B. Self concept mode

1. OXYGENATION 1. PHYSICAL SELF
Hypoxia Decreased sexual self concept
Shock Aggressive sexual behavior
Overload Loss
1. NUTRITION 2. PERSONAL SELF
Malnutrition Anxiety
Nausea Powerlessness
Vomiting Guilt

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3. ELIMINATION Low self esteem
Constipation
Diarrhea C. Role function mode
Flatulence Role transition
Incontinence Role distance
Urinary retention Role conflict
4. ACTIVITY &REST Role failure
Inadequate physical activity
Potential disuse consequences D. Interdependence mode
Inadequate rest Separation anxiety
Insomnia Loneliness
Sleep deprivation
Excessive rest
5. SKIN INTEGRITY
Itching
Dry skin
Pressure sores

 The second method is to make a diagnosis by stating the observed behavior along with the
most influencing stimuli.
 The third method summarizes behaviors in one or more adaptive modes related to the same
stimuli.
On the other hand, nursing diagnosis using any of the above methods can also be a
statement of adaptive behaviors that the nurse wishes to support.
Many nurses are familiar with the work of NANDA and the list of nursing diagnosis that
have been accepted for testing through their seven conferences. In the second edition of
Introduction to Nursing: An Adaptation Model, chapter author began to identify NANDA
diagnoses related to each adaptive mode. As the second edition predates the most recent
NANDA taxonomy, a correlation of adaptive modes and the NANDA list has not been
published by Roy or her co-authors. However, the following trends are developed by Roy and
others;

ROY’S ADAPTIVE MODES AND NANDA NURSING DIAGNOSES

Adaptive Mode NANDA Nursing Diagnoses

Physiological Mode
Activity and rest Mobility: Impaired physical
Self-care deficit: Feeding
Self-care deficit: Bathing-hygiene
Self-care deficit: Dressing-grooming
Self-care deficit: Toileting
Potential for infection
Diversional activity deficit
Sleep pattern disturbance
Activity intolerance
Potential activity intolerance

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 Impaired home maintenance management
Altered growth and development

Elimination Altered urinary elimination pattern

Urinary retention
Functional incontinence
Reflex incontinence
Stress incontinence
Urge incontinence
Total incontinence
Alteration in bowel elimination: Constipation
Alteration in bowel elimination: Diarrhea
Alteration in bowel elimination: Incontinence

Endocrine function Sexual dysfunction

Rape trauma syndrome
Rape trauma syndrome: Compound reaction
Rape trauma syndrome: Silent reaction
Altered sexuality patterns

Fluid and electrolytes Potential volume deficit

Fluid volume excess
Actual fluid volume deficit
Potential fluid volume deficit

Neurological function Altered thought processes

Knowledge deficit (specify)
Ineffective thermoregulation
Hyperthermia
Hypothermia

Nutrition Alteration in oral mucus membrane

Alteration in nutrition: Potential for more than
body requirements
Alteration in nutrition: Less than body requirements
Alteration in nutrition: More than body requirements
Impaired swallowing
Potential alteration in body temperature

Oxygenation Alteration in tissue perfusion: Renal, cerebral,

cardiopulmonary, gastrointestinal, peripheral
Ineffective airway clearage
Ineffective breathing pattern
Impaired gas exchange

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 Altered cardiac output: Decreased

Senses Alteration in comfort: Pain

Alteration in comfort: Chronic pain
Sensory perceptual alteration
Unilateral neglect

Skin integrity Impaired skin integrity

Potential for infection
Potential for injury
Potential for injury: Trauma
Potential for injury: Poisoning
Potential for injury: Suffocation
Impaired tissue integrity

Self Concept Mode Self esteem disturbance in self concept

Personal identity disturbance in self concept
Anxiety
Body image disturbance
Ineffective individual coping
Depression
Fear
Alteration in health maintenance
Impaired adjustment
Identity confusion, personal
Powerlessness
Spiritual distress
Noncompliance
Hopelessness
Post trauma response

Role Function Mode Alteration in family process

Family coping: Potential for growth
Ineffective family coping
Potential alteration in parenting
Actual alteration in parenting
Impaired verbal communication

Interdependence Mode Anticipatory grieving

Dysfunctional grieving
Translocation syndrome
Social isolation
Potential for violence
Impaired social interaction
Spiritual distress

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GOAL SETTING
Goals are the end point behaviors that the person is to achieve. They are recorded as client
behaviors indicative of resolution of the adaptation problem. Long term goals would reflect
resolution of adaptive problems and the availability of energy to meet other goals. Short term
goals identify expected client behaviors after manipulation of focal, contextual, or residual
stimuli, as well as, state client behaviors that indicate cognator or regulator coping. Goals,
whenever possible, are set mutually with the person. Mutual goal setting respects the privileges
and rights of the person.

PLANS FOR IMPLEMENTATION

Nursing implementations are planned with the purpose of altering or manipulating the
focal, contextual, or residual stimuli. Implementation may be focus on broadening the person’s
coping ability, or adaptation zone, so that the total stimuli fall within that person’s ability to
adapt.

EVALUATION
The nursing process is completed by evaluation. Goal behaviors are compared to the
person’s output behaviors and movement toward or away from goal achievement is
determined. Readjustments to goals and interventions are made, based on evaluation data.

ROY’S WORK AND THE CHARACTERISTICS OF A THEORY

1. Theories can interrelate concepts in such a way as to create a different way of looking
at a particular phenomenon. The Roy model does interrelate concepts in such a way as to
present a new view of the phenomenon being studied. It identifies the key concepts relevant to
nursing: the person, environment, health, and the goal of nursing. The person is viewed as
constantly interacting with internal and external stimuli. The person is active and reactive to
these stimuli. Stimuli are defined as focal, contextual and residual. Adaptation is a positive
response by the person. Adaptation is facilitated by the use of the cognator and regulator
coping mechanisms. The adaptation level represents the range of stimuli that the person can
tolerate and maintain an adaptive response. The areas of behavior where the effects of coping
are evidenced include the four adaptive modes. Thus, by quick review of the concept of the
person who is the recipient of care, one sees that a very specific perspective or image has been
defined by the Roy Model. The view suggests a holistic framework as opposed to a view of the
ill person as a biological entity with a disease process. It reflects a view of nursing that is
concerned with many aspects of the person, physiological, self-concept, role function and
interdependence.
2. Theories must be logical in nature. The sequence of concepts of the Roy model follows
logically. In the presentation of each of the key concepts, there is the recurring idea of
adaptation to maintain integrity. The definition of health is based on the idea of integrity
which in turn is operationalized to mean behaviors which meet the person’s goals. The
person is conceptualized as a holistic, adaptive system.
3. Theories should be relatively simple yet generalizable. The concepts of the model are
stated in relatively simple terms. However, the concept of the person as an adaptive system

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 does present a challenging use of specific terms including cognator and regulator
mechanisms and adaptation level. The four adaptive modes may be the first aspect of the
model that the student or nurse is able to assimilate. Based upon nursing tradition, assessment
of fluids and electrolytes, elimination, oxygenation, roles and such evoke familiar images.
Let us also consider the generalizability of the model in various settings. Literature
speaks positively to the generalizability of the model to various client populations. Use in
curriculum development also demonstrates generalizability.
4. Theories can be the basis for hypotheses that can be tested, and
5. Theories contribute to and assist in increasing the general body of knowledge of a
discipline through the research implemented to validate them. The testing of a theory in
practice is the basis for scientific development of a profession. Because presents her work as
a model, subtheorizing is present when application of the model is made for predictive
understanding in a clinical situation. The model must be able to clearly identify the
connecting relationships between underlying theories. Testable hypothesis are thus
generated. Because the model is an umbrella that is capable of linking theories, its
contributions in the future to the body of nursing knowledge may be considerable.
6. Theories can be utilized by the practitioners to guide and improve their practice.
Perhaps the most important aspect of a theory is its usefulness in practice. A major strength of
the model is that it guides nurses to utilize observation and interviewing skills in doing an
individualized assessment of each person. In considering all the adaptive modes, the nurse is
likely to have a comprehensive view of the person.
The concepts of the model are applicable within many practice settings of nursing.
Literature reflects application of the model by nurse educators, practitioners, and researchers in
a variety of educational and clinical settings. In practice settings which require quick action,
the elements of the model are still compatible with quality care. Practitioners can see the
importance of their actions in influencing the adaptation of the person.
7. Theories must be consistent with other validated theories, laws, and principles but
will leave open unanswered questions that need to be investigated. The model, by its
structure, requires the integration of further theorizing for explanatory and predictive
information in clinical situations. The concept of adaptation as developed by the model appears
to have good linkage qualities. Theory development has been undertaken by Roy, her co-
authors, and others. Future nursing research and field application will continue to validate and
adjust the Roy model.

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