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312 UNIT III Nursing Conceptual Models

related to adaptation levels of persons. Roy also uses 3. Makes a statement or nursing diagnosis of the
other concepts and theory outside the discipline of person’s adaptive state
nursing and synthesizes these within her adaptation 4. Sets goals to promote adaptation
theory. 5. Implements interventions aimed at managing the
Roy’s adaptation theory is inductive in that she stimuli to promote adaptation
developed the four adaptive modes from research and 6. Evaluates whether the adaptive goals have been met
nursing practice experiences of herself, her colleagues, By manipulating the stimuli and not the patient, the
and her students. Roy built on the conceptual frame- nurse enhances “the interaction of the person with their
work of adaptation and developed a step-by-step environment, thereby promoting health” (Andrews &
model by which nurses use the nursing process Roy, 1986, p. 51). The nursing process is well suited for
to administer nursing care to promote adaptation use in a practice setting. The two-level assessment is
in situations of health and illness (Roy, 1976a, 1980, unique to this model and leads to the identification of
1984). adaptation problems or nursing diagnoses.
Roy and colleagues have developed a typology of
Acceptance by the Nursing Community nursing diagnoses from the perspective of the Roy
Adaptation Model (Roy, 1984; Roy & Roberts, 1981).
Practice In this typology, commonly recurring problems have
The Roy Adaptation Model is deeply rooted in nursing been related to the basic needs of the four adaptive
practice, and this, in part, contributes to its continued modes (Andrews & Roy, 1991).
success (Fawcett, 2002). It remains one of the most fre- Intervention is based specifically on the model, but
quently used conceptual frameworks to guide nursing there is a need to develop an organization of categories
practice, and it is used nationally and internationally of nursing interventions (Roy & Roberts, 1981). Nurses
(Roy & Andrews, 1999; Fawcett, 2005). provide interventions that alter, increase, decrease,
Roy’s model is useful for nursing practice, because remove, or maintain stimuli (Roy & Andrews, 1999).
it outlines the features of the discipline and provides The nursing judgment model outlined by McDonald
direction for practice, education, and research. The and Harms (1966) is recommended by Roy to guide
model considers goals, values, the patient, and practi- selection of the best intervention for modifying a par-
tioner interventions. Roy’s nursing process is well ticular stimulus. According to this model, a number
developed. The two-level assessment assists in identi- of alternative interventions are generated that may be
fication of nursing goals and diagnoses (Brower & appropriate for modifying the stimulus. Each possible
Baker, 1976). intervention is judged for the expected consequences
Early on, it was recognized as a valuable theory of modifying a stimulus, the probability that a conse-
for nursing practice because of the goal that specified quence will occur (high, moderate, or low), and the
its aim for activity and a prescription for activities value of the change (desirable or undesirable).
to realize the goal (Dickoff, James, & Wiedenbach, Senesac (2003) reviewed the literature for evidence
1968a, 1968b). The goal of nursing and of the model that the Roy Adaptation Model is being implemented
is adaptation in four adaptive modes in a person’s in nursing practice. She reported that the Roy Adap-
health and illness. The prescriptive interventions are tation Model has been used to the greatest extent by
when the nurse manages stimuli by removing, individual nurses to understand, plan, and direct
increasing, decreasing, or altering them. These pre- nursing practice in the care of individual patients.
scriptions may be found in the list of practice-related Although fewer examples of implementation of the
hypotheses generated by the model (Roy, 1984). adaptation model are found in institutional practice
When using Roy’s six-step nursing process, the settings, such examples do exist. She concluded that if
nurse performs the following six functions: the model is to be implemented successfully as a prac-
1. Assesses the behaviors manifested from the four tice philosophy, it should be reflected in the mission
adaptive modes and vision statements of the institution, recruitment
2. Assesses the stimuli for those behaviors and catego- tools, assessment tools, nursing care plans, and other
rizes them as focal, contextual, or residual stimuli documents related to patient care.