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310 UNIT III Nursing Conceptual Models

Health and illness is one inevitable, coexistent ineffective response. Adaptive responses promote integ-
dimension of the person’s total life experience (Riehl rity and help the person to achieve the goals of adapta-
& Roy, 1980). Nursing is concerned with this dimen- tion, that is, they achieve survival, growth, reproduction,
sion. When mechanisms for coping are ineffective, mastery, and person and environmental transforma-
illness is the result. Health ensues when humans con- tions. Ineffective responses fail to achieve or threaten the
tinually adapt. As people adapt to stimuli, they are goals of adaptation. Nursing has a unique goal to assist
free to respond to other stimuli. The freeing of energy the person’s adaptation effort by managing the environ-
from ineffective coping attempts can promote healing ment. The result is attainment of an optimal level of
and enhance health (Roy, 1984). wellness by the person (Andrews & Roy, 1986; Randell,
Tedrow, & Van Landingham, 1982; Roy, 1970, 1971,
Environment 1980, 1984; Roy & Roberts, 1981).
According to Roy, environment is “all the conditions, As an open living system, the person receives
circumstances, and influences surrounding and affect- inputs or stimuli from both the environment and
ing the development and behavior of persons or groups, the self. The adaptation level is determined by the
with particular consideration of the mutuality of person combined effect of focal, contextual, and residual
and earth resources that includes focal, contextual, and stimuli. Adaptation occurs when the person responds
residual stimuli” (Roy & Andrews, 1999, p. 81). “It is the positively to environmental changes. This adaptive
changing environment [that] stimulates the person to response promotes the integrity of the person, which
make adaptive responses” (Andrews & Roy, 1991, p. 18). leads to health. Ineffective responses to stimuli lead to
Environment is the input into the person as an adaptive disruption of the integrity of the person (Andrews &
system involving both internal and external factors. Roy, 1986; Randell, Tedrow, & Van Landingham,
These factors may be slight or large, negative or posi- 1982; Roy, 1970, 1971, 1980; Roy & McLeod, 1981).
tive. However, any environmental change demands There are two interrelated subsystems in Roy’s model
increasing energy to adapt to the situation. Factors in (Figure 17–1). The primary, functional, or control pro-
the environment that affect the person are categorized cesses subsystem consists of the regulator and the cog-
as focal, contextual, and residual stimuli. nator. The secondary, effector subsystem consists of the
following four adaptive modes: (1) physiological needs,
(2) self-concept, (3) role function, and (4) interdepen-
Theoretical Assertions dence (Andrews & Roy, 1986; Limandri, 1986; Mastal,
Roy’s model focuses on the concept of adaptation of the Hammond, & Roberts, 1982; Meleis, 1985, 2007; Riehl
person. Her concepts of nursing, person, health, and & Roy, 1980; Roy, 1971, 1975).
environment are all interrelated to this central concept. Roy views the regulator and the cognator as meth-
The person continually experiences environmental ods of coping. The regulator coping subsystem, by way
stimuli. Ultimately, a response is made and adaptation of the physiological adaptive mode, “responds auto-
occurs. This response may be either an adaptive or an matically through neural, chemical, and endocrine

Input Control Effectors Output
processes

Coping Physiological function Adaptive
Stimuli mechanisms Self-concept and
Adaptation Regulator Role function ineffective
level
Cognator Interdependence responses

Feedback
FIGURE 17-1 Person as an adaptive system. (From Roy, C.. [1984]. Introduction to nursing: An adaptation
model [2nd ed., p. 30]. Englewood Cliffs, NJ: Prentice Hall.)