The theorist I thought most suited for this
particular subject is Callista Roy’s theory.

Callista Roy is a member of the sisters of
ST. Joseph of  Carondelet .she was born
in 1939in los Angeles, California .she obtained a BA in Nursing in 1963 from
Mount st Mary’s college ,los Angeles and a masters of science in nursing from
the university of California in 1966.her PhD was in sociology from the
university of California in 1977.she began to develop her concepts of nursing
while studying for her masters.

Roy (1976) sees her model as having three
elements: the recipient of nursing care, the goal of nursing, and nursing
activities. The recipient of nursing care she describes as ‘a biosocial being
in constant interaction with a changing environment’ (p. 11). In this
constantly changing environment people cope through innate and acquired
biological, psychological and social mechanisms. An example she gives of innate
biological mechanisms is blood dotting following injury; an example of an
acquired mechanism is learning. This positive response to the changing
environment Roy calls adaptation. She uses Helson’s (1964) work to describe
this process. He calls the ability of the person to adapt in the face of change
the individual’s ‘adaptation level’. The adaptation level results from three
stimuli: the focal stimulus, that immediately confronting the individual; the
contextual stimuli, all the other stimuli present and relevant to the
individual at the time; and the residual stimuli, the factors the individual
brings to the situation such as attitudes, beliefs, experiences, traits, etc.
An individual’s adaptive response has the function of maintaining the person’s
integrity, while a maladaptive response disrupts integrity. Roy identifies two
major adaptive mechanisms: the regulator, which works through the autonomic
nervous system; and the cognator, which is the level of recognition and
understanding of the situation. Roy sees humans as adapting in four ways: •
physiological: exercise and rest; nutrition; elimination; fluid and
electrolytes; oxygen; circulation; temperature regulation; the senses and the
endocrine system; • self-concept, divided into two aspects – the personal self,
consisting of the moral-ethical self, self-consistency, self-ideal and
self-esteem, and the physical self;

Summary of the Roy adaptation model 45

• role function; • interdependence.

The role function and interdependence modes
are related to the need for social integrity. All the modes are seen as interrelated,
therefore change will create the need for adaptation in more than one mode.
Internal or external environmental changes create a need that results in the
individual making an internal and/or external response; this is seen in
behaviour and is activated in order to reduce the need. The goal of nursing is
to promote or sustain adaptation in each of the modes; this is where needs have
resulted from situations which create deficits or excesses in the individual.
The way the nurse works is through the nursing process. This approach, using
Roy’s model, has six stages. The first stage is first level assessment in the
four modes and involves the nurse observing the patient’s behaviours and
questioning the patient in order to measure the internal and external responses
of the patient to change. This stage ends when a judgement is made of whether
the individual’s behaviour is adaptive or maladaptive and will depend on
whether the behaviour promotes integrity. The second stage involves assessment
of focal, contextual and residual stimuli where the behaviour is maladaptive or
needing reinforcement. The four further stages of the nursing process involve
the diagnosis of adaptation problems, which involve criteria for setting
priorities; establishing goals for removal of the focal stimulus, or changing
the contextual or residual stimuli; intervention, where the nurse manipulates
the stimuli by removing, increasing or decreasing them; and evaluation of the
effectiveness of the intervention by enabling the patient to adapt. Roy
recognizes that much of the knowledge needed to use this model effectively is
not known as yet, and that whereas normal states are known in some areas of the
biological mode, in the self-concept, role function and interdependence modes
knowledge is sketchy or absent at present. In Riehl and Roy (1980) the model
remains essentially unchanged. The adaptive modes are enlarged. The
physiological mode remains the same as in Roy (1976), but the self-concept mode
now includes the physical self, the personal self and the interpersonal self.
The role mastery mode now has two categories: role function and role conflict;
and the interdependence mode contains a similar list of examples as seen in Roy
(1976). In the second edition of her model (Roy, 1984) there is again
essentially no change, but there is fuller development than in the first
edition. One development is the adaptive mechanisms of the regulator and the
cognator. The regulator is defined as (p. 31): … receiving input from the
external environment and from changes in the person’s internal state. It then
processes the changes through neural-chemical-endocrine channels

46 Roy’s model of adaptation

to produce responses.’ These changes and
responses are then more clearly outlined. The cognator is also developed and
enlarged (p. 33):

The internal and external stimuli trigger
off four kinds of processes: perceptual/ information processing, learning,
judgement, and emotion. Under perceptual/information processing, we may
consider the person’s internal activity of selective attention, coding, and
memory. Learning involves such processes as imitation, reinforcement, and
insight. The judgement process includes problem-solving and decision-making.
Through the emotional pathways, the person uses defenses to seek relief and
effective appraisal and attachment.

Other amendments to the 1984 edition of her
model are in the adaptive modes. The physiological mode has been reduced to
five categories which are oxygenation, nutrition, elimination, activity and
rest, and skin integrity. The self-concept mode is reduced to two modes,
physical self and personal self; the role function and interdependence modes
remain essentially unchanged. Despite the considerable amount of written work
and development of the model, the research in practice settings using this
framework has been slow, particularly when one considers that the model has
been in existence for well over a decade.