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CHAPTER 17 Sister Callista Roy 315

problems, coping mechanisms, and interventions an excellent fit with stage of illness, laboratory values
based on laws derived from factors that make up the (white blood cell count, hemoglobin, platelets, abso-
response potential of focal, contextual, and residual lute neutrophil count), and total number of hospital-
stimuli. Roy and colleagues have outlined a typology izations. Although it is not altogether clear how the
of adaptation problems or nursing diagnoses (Roy, focal and contextual stimuli were defined, this study
1973, 1975, 1976b). Research and testing continue in showed that environmental stimuli (severity of
the areas of typology and categories of interventions illness, age, gender, understanding of illness, and
that have been derived from the model. General prop- communication with others) influence the biopsy-
ositions also have been developed and tested (Roy & chosocial adaptive responses of children to cancer.
McLeod, 1981). Finally, this study demonstrated the interrelatedness
of the physiological (physical HRQOL), self-concept
Practice-Based Research (disease and symptoms HRQOL), interdependence
DiMattio and Tulman (2003) described changes (social HRQOL), and role function (cognitive
in functional status and correlates of functional status HRQOL) adaptive modes.
of 61 women during the 6-week postoperative period Woods and Isenberg (2001) provide an example of
following a coronary artery bypass graft. Functional theory synthesis. In their study of intimate abuse and
status was measured at 2, 4, and 6 weeks after surgery, traumatic stress in battered women, they developed a
using the Inventory of Functional Status in the Elderly middle-range theory by synthesizing the Roy Adapta-
and the Sickness Impact Profile. Significant increases tion Model with the current literature reporting on
were found in all dimensions of functional status except intimate abuse and post-traumatic stress disorder.
personal at the three measurement points. The greatest A predictive correlational model was used to examine
increases in functional status occurred at between 2 and adaptation as a mediator of intimate abuse and post-
4 weeks after surgery. However, none of the dimensions traumatic stress disorder. The focal stimulus of this
of functional status had returned to baseline values at study was the severity of intimate abuse, emotional
the 6-week point. This information will help women abuse, and risk of homicide by an intimate partner.
who have undergone coronary artery bypass graft sur- Adaptation was operationalized within the four adap-
gery to better understand the recovery period and to set tive modes and was tested as a mediator between
more realistic goals. intimate abuse and post-traumatic stress disorder.
Young-McCaughan and colleagues (2003) studied Direct relationships were reported between the focal
the effects of a structured aerobic exercise program on stimulus and intimate abuse, and adaptation in each
exercise tolerance, sleep patterns, and quality of life in of the four modes mediated relationships between the
patients with cancer from the perspective of the Roy focal stimulus and traumatic stress.
Adaptation Model. Subjects exercised for 20 minutes, Chiou (2000) conducted a meta-analysis of the
twice a week, for 12 weeks. Significant improvements interrelationships among Roy’s four adaptive modes.
in exercise tolerance, subjective sleep quality, and Using well-defined inclusion and exclusion criteria, a
psychological and physiological quality of life were literature search of the Cumulative Index to Nursing
demonstrated. and Allied Health Literature yielded eight research
Yeh (2002) tested the Roy Adaptation Model in reports with diverse samples. One in-press report was
a sample of 116 Taiwanese boys and girls with cancer included. Convenience samples for the nine studies
(7 to 18 years of age at the time of diagnosis). Two included only adults, and some were elderly. The
Roy propositions were tested. The first proposition is meta-analysis revealed small to medium correlations
that environmental stimuli (severity of illness, age, between each two mode set and a nonsignificant
gender, understanding of illness, and communication association between the interdependence and physi-
with others) influence biopsychosocial responses ological modes. Zhan (2000) found support for
(health-related quality of life [HRQOL]). The second Roy’s proposition about cognitive adaptive processes
proposition is that the four adaptive modes are inter- in relation to maintaining self-consistency. Using
related. Using structural equation modeling, the Roy’s Cognitive Adaptation Processing Scale (Roy &
researcher found that severity of illness provided Zhan, 2001) to measure cognitive adaptation and the