Sister Callista Roy Ph.D., RN, FAAN Background

1. Sister Callista Roy Ph.D., RN, FAANBackground Sister Callista Roy RN, Ph.D., is a nurse theorist, college professor, researcher, writer, and lecturer. She is best known for the development of the Roy Adaptation Model (RAM). RAM is a theoretical approach to nursing and is widely used in nursing practice, education, and research. One of her core values is the belief in the basic human good of people. Callista Roy was born on October 14, 1939 in Los Angeles, California. She is the 2nd of fourteen children in her family. During her high school years, she was fortunate to work as a nurse’s aide at the hospital where her mother worked as a nurse. Upon graduating high school, she entered the Sister of St. Joseph of Carondelet. Sister Callista Roy received a four-year scholarship to Mount Saint Mary’s College in Los Angeles, where she received her Bachelor of Arts with a major in nursing in 1963. She worked one year as a staff nurse in Tucson, Arizona working in pediatrics. She then started to work on her Master's Degree at UCLA. After receiving her Master's Degree in pediatric nursing in 1966, Sister Callista Roy returned to her Alma Mater Mount Saint Mary's College, where she taught on and off for seventeen years. In 1975, she received a Master's in Sociology from UCLA, followed by her Doctoral Degree in Sociology in 1977. Dr. Roy received one of the very first Postdoctoral Fellowships from the Robert Wood Johnson Foundation. She conducted her postdoctoral studies at the University of California in San Francisco focusing on neuroscience nursing. (Alumni UCLA, 2012 UCLA awards; Boston College, 2013. Featured faculty; UCDenver, 2012. Nurse theorists portraits of excellence)

2. Background While Sister Callista Roy was working as a pediatric nurse,she noticed how children were able to adapt to physical and psychological experiences. This led to her creation of the Roy Adaptation Model. The model gives a path for what nurses can do to help patients deal with health challenges. The Roy Adaptation Model was first published in 1970. (Sacred Heart University, 2013. Nursing grand theory and theorists; Masters, 2012) Today Dr. Roy is a professor and nurse theorist at Boston College where she has been for the last twenty-six years. She is also a Faculty Senior Nurse Scientist at Massachusetts General Hospital. Roy continues to refine and redefine the Roy Adaptation Model. Dr. Roy has over 130 publications including twelve books, many of which have been translated into other languages. Roy has presented lectures and workshops in over thirty countries on topics related to nursing theory, research curriculum, clinical practice, and professional trends in nursing. Dr. Roy has received many awards and accolades including: • Fellow of the American Academy of Nursing • Named a Living Legend by the American Academy of Nursing • Inaugural member of the Sigma Theta Tau International Nurse Researcher Hall of Fame (Alumni UCLA, 2012. UCLA awards; Boston College, 2013. Featured faculty)

3. The Roy Adaptation Model The Roy Adaptation Model (RAM) is one of the most applied models in nursing practice, research, and education today. The central concept of RAM is that the person is an adaptive system that needs to respond positively to the environmental changes of focal, contextual,and residual stimuli.  Dr. Roy proposed that the goal of nursing was promoting patient adaptation. Four elements are included in the Roy Adaptation Model: person, nursing, health, and environment. People are seen as living adaptive systems and their behaviors may be classified as either adaptive responses or ineffective responses. According to the Roy Adaptation Model, the goal of nursing is to promote adaptive responses with respect to the four adaptive modes: 1) Physiological/physical, 2) Self-concept/group identity, 3) Role function, and 4) Interdependence. Health is the process of being able to meet the goals of survival, growth, reproduction, and mastery. The environment is composed of the internal and external stimuli that exist around an individual. (Boston College, 2013. The Roy adaptation model; Current Nursing, 2012. Roy’s adaptation model)

4. Person Person:  In nursing care, the main focus is the person who is the recipient of the care.  RAM focuses on the metaparadigm of person as a holistic adaptive system with coping mechanisms manifested by four adaptive modes: physiologic, self concept, role concept, and interdependence.  This system is described as a whole compromised of parts that functions as a unity for some purpose.  It includes people as individuals or in groups (families, organizations, communities, nations, and society as a whole).     1. Physiologic:  The physiologic mode deals with the maintenance of the physical body.     -In the individual, there are five needs:             1. Oxygenation             2. Nutrition             3. Elimination             4. Activity             5. Rest and protection     -There are also four regulatory processes:             1. The senses             2. Fluids and electrolytes             3. Neurologic             4. Endocrine functions     2. Self Concept: The self concept mode deals with the maintenance of the mind.  The person's perception of his or her physical and personal self are included in this mode.     3. Role Function:  Roles that individuals occupy in society, fulfilling the need for social integrity such as role development, instrumental and expressive behaviors, and role taking process.  This addresses people's adaptations to different role changes that occur throughout a lifetime. It is knowing who one is in relation to others.       4. Interdependence:  The close relationships of people and their purpose, structure, and development individually and in groups.  It involves ways of seeking help, affection, and attention.  It is the ability to love, respect, value, and accept. (Boston College, 2013. The Roy adaptation model; Current Nursing, 2012. Roy’s adaptation model; Masters, 2012)

5. Environment Environment:A person's environment is in constant change.  Dr. Roy's model relates to the metaparadigm of environment in that in order to respond positively to one's changing environment, they must adapt to all the stimuli they encounter.  The goal of nursing care is to help the patients to adopt positive responses to the various stimuli of their environment.  A patient's environment includes both internal and external stimuli consisting of all conditions, circumstances, and influences that surround and affect the development and behavior of people and groups with particular consideration of mutuality of person and earth resources.  These may be viewed as inputs into the adaptive model that affect transformation.  The environment has three components:  • Focal: Stimuli that is internal or external and immediately confronts the person • Contextual: All stimuli present in the situation that all contribute to the effect of the focal stimulus • Residual: Stimuli whose effects in the current situation are unclear Nursing should promote adaption interventions to help the patients respond positively to the stimuli of their environment so as to contribute to their overall health and quality of life. (Boston College, 2013. The Roy adaptation model; Current Nursing, 2012. Roy’s adaptation model; Masters, 2012)

6. Health • Health:The Roy Adaptation Model focuses on the metaparadigm of health on the process and outcome of adaptation. A person's health will be influenced by his or her adaptive abilities to: • Inevitable dimension of person's life  • Represented by a health-illness continuum  • A state and a process of being and becoming integrated and whole, reflecting  a person and environment mutuality  • Roy wrote about health existing as a continuum in her early writings. However, she now views this conceptualization of health as “simplistic and unrealistic since it does not accommodate the existence of wellness and illness, and excludes individuals with chronic disabilities or terminal illness who are dealing effectively with life’s challenges, in spite of their conditions.” (Masters, 2012) • Roy’s writing began to focus on health as a process in which illness and health can coexist. (Roy, 2009)

7. Nursing • Nursing: The Roy Adaptation Model is extremely useful in nursing. Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation. (Roy, 2009) The goal of promoting adaptation contributes to the patients’ health, quality of life,and dying with dignity.  In order to achieve these goals,the nurse must determine an individual’s ability to adapt.  The nurse can make this determination by thoroughly assessing behaviors as well as identifying factors that could potentially inhibit the patient’s adaptation ability. • To incorporate Roy’s adaptive model into practice,the following 6 steps should be used: • 1. Assess the behaviors from the four adaptive modes using observational skills, intuition, accurate measurements, and interviewing skills: •        Physiological – physical  •        Self-concept – group  •        Role function •       Interdependence  • 2.  Assess and categorize the stimuli for those behaviors into the following categories: •       Focal: Stimuli that is internal or external and immediately confronts the person •       Contextual: All stimuli present in the situation that all contribute to the effect of the focal stimulus •       Residual: Stimuli whose effects in the current situation are unclear (Boston College, 2012) • 3.  Make a nursing diagnosis based on the persons adaptive state: •       The wording of the diagnosis is a key facilitator in the development of goals  • 4.  Set goals to promote adaptation: •       Goals should identify the behavior to be observed in addition to the way the behavior is expected to change • 5. Implement interventions aimed at managing stimuli to promote adaptation: •       Interventions can include changing of stimuli and/or strengthening the adaptive processes •       During this phase,the nurse should work in collaboration with the patient to determine what outcomes are considered desirable vs. undesirable • 6. Evaluate achievement of adaptive goals:  •      The nurse employs the skills of observation, intuition, measurement,and interviewing to evaluate and determine if the goals have been met (Boston College, 2013. The Roy adaptation model; Masters, 2012; Roy, 2009)

8. Application of Theory To Practice • Nurses can use The Roy Adaptation Model (RAM) in the treatment of their patients to gather data, discover the needs of the patient's adaptive system, develop nursing care, and evaluate the effectiveness of the care provided.  An application of this model in practice can be seen in the following example. A nurse is caring for a young patient named Julie with Type I diabetes.  With help from her mom, Julie did a good job managing her diabetes from early age.  Now in her teenage years, she is not managing her diabetes as well.  RAM can be used by a nurse in the care of Julie by: • Adaptation:  How is Julie coping with being a teenager in high school having to take insulin injections? • Person:  How does Julie see herself in comparison to her friends that do not have diabetes? • Environment: How is being a teenager and the friendships developed in high schoolinfluenceJulie's management of her diabetes?   • Health: How is Julie's management of her diabetes affecting her overall health? • Nursing: As a nurse, what nursing care plan can I develop to help Julie now that she is a teenager facing new challenges with being a diabetic?  What is the nursing diagnosis and what interventions can be implemented?  What goals can we set, and how will we measure the effectiveness of the nursing care?

9. Application of Theory To Practice • Adaptive Modes: • Physiological – physical    > Compromised level of adaptation, shown in blood glucose level • Self-concept –   > Compensates for feeling different – does not tell friends she • group identity has diabetes • Role function   > Her roles are beginning to change – will change more throughout high school • Interdependence   > Good relationship with parents, but wants to handle things herself • A nurse can use RAM as a tool to speak with Julie to see how she is dealing with rapid periods of growth, influences from peers, more activities away from home, and new stresses at school.  All of these issues (stimuli) can be affecting how Julie is now managing her diabetes.  The nurse and Julie can work together on a plan that will help Julie adapt as a person who is now a teenager experiencing a new environment with changing influences, as well as new challenges to her health.  The nurse can develop a nursing plan with specific goals that will help contribute in a positive way to Julie's health and overall well being.  This plan should help Julie attain her goal of becoming an expert on managing her diabetes throughout her teen-age years.

10. Conclusion

11. References Alumni UCLA (2012). UCLA awards. Retrieved from http://alumni.ucla.edu/share/ucla-awards/bio/callista-roy.aspxBoston College (2013). Featured faculty theorist. Retrieved from http://www.bc.edu/schools/son/faculty/featured/theorist.html Boston College (2013). The Roy adaptation model. Retrieved from http://www.bc.edu/content/bc/schools/son/faculty/featured/theorist/Roy_Adaptation_Model.html Current Nursing (2012). Roy’s adaptation model. Retrieved from http://currentnursing.com/nursing_theory/Roy_adaptation_model.html Masters, K. (2012). Roy Adaption Model: Sister Callista Roy. Nursing theories: a framework for professional practice (p. 128). Sudbury, MA: Jones & Bartlett Learning. Roy, Sr. C. (2009). The Roy adaption model (3rd ed.). Upper Saddle River, NJ: Pearson.Sacred Heart University (2013). Nursing grand theory and theorists. Retrieved from http://nursingtheoryandtheoristsroyorem.weebly.com/about-sr-callista-roy.html UC Denver (2012). Nurse theorists portraits of excellence, vol. 1 Callista Roy adaptation model. Retrieved from http://www.fitne.net.hsl-ezproxy.ucdenver.edu/vlrc/user/content/nt_cr/index.htmlFigure 1 retrieved from http://aquichan.unisabana.edu.co/index.php/aquichan/article/view/1527/1974 Photo image retrieved from http://knowledgenurse.files.wordpress.com/2011/08/callista_roy.png