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CHAPTER 17 Sister Callista Roy 317

studying adaptation to a variety of environmental Development of Middle-Range Theories
stimuli. Four groups of individuals were included in of Adaptation
their studies as follows: (1) informal family caregivers Silva (1986) pointed out early on that merely using a
of a demented relative at home, (2) informal family conceptual framework to structure a research study is
caregivers of a psychiatrically ill relative at home, not theory testing. Many researchers have used Roy’s
(3) nurses as professional caregivers in geriatric insti- model but did not actually test propositions or
tutions, and (4) aged spouses in the community. hypotheses of her model. They have provided face
Using linear structural relations (LISREL), perceived validity of its usefulness as a framework to guide their
stress (focal stimulus), social support (contextual studies. How theory derives from a conceptual frame-
stimulus), and passive and avoidance coping (coping work must be made explicit; therefore, development
mechanism) were directly or indirectly linked to psy- and testing of middle-range theories derived from the
chological distress. This finding supports Roy’s prop- Roy Adaptation Model are needed. Some research of
osition that coping promotes adaptation. this nature has been conducted with the model, but
DeSanto-Madeya (2009) studied adaptation in more is needed for further validation and develop-
individuals with spinal cord injury and their family ment of new areas. The model does generate many
members using the Roy Adaptation Model. In this testable hypotheses related to both practice and nurs-
study, fifteen patient and family member dyads were ing theory. The success of a conceptual framework
included. Of the fifteen dyads, seven dyads were is evaluated, in part, by the number and quality
1 year postinjury, and eight dyads were 3 years postin- of middle-range theories it generates. The Roy Adap-
jury. Telephone interviews using the Adaptation to tation Model has been the theoretical source of
Spinal Cord Injury Interview Schedule (ASCIIS) were a number of middle-range theories (Roy, 2011a). The
conducted. Findings showed that both individuals utility of those theories in practice sustains the life of
and families had moderate adaptation scores at both the model.
1 year and 3 years. Study findings have important Dunn (2004) reports the use of theoretical sub-
implications for nurses who must care for spinal cord struction to derive a middle-range theory of adapta-
injury patients in both acute and outpatient care tion for chronic pain from the Roy Adaptation Model.
settings. In Dunn’s model of adaptation to chronic pain, pain
intensity is specified as the focal stimulus. Contextual
Development of Adaptation Research stimuli include age, race, and gender. Religious and
Instruments nonreligious coping are functions of the cognator
The Roy Adaptation Model has provided the theoreti- subsystem. Manifestations of adaptation to chronic
cal basis for the development of a number of research pain are its effects on functional ability and psycho-
instruments. Newman (1997b) developed the Inven- logical and spiritual well-being.
tory of Functional Status–Caregiver of a Child in a Frame, Kelly, and Bayley (2003) developed the
Body Cast to measure the extent to which parental Frame theory of adolescent empowerment by synthe-
caregivers continue their usual activities while a child sizing the Roy Adaptation Model, Murrell-Armstrong’s
is in a body cast. Reliability testing indicates that the empowerment matrix, and Harter’s developmental
subscales for household, social, and community child perspective. The theory of adolescent empowerment
care of the child in a body cast, child care of other was tested using a quasi-experimental design in which
children, and personal care (rather than the total children diagnosed with attention-deficit/hyperactivity
score) are reliable measures of these constructs. disorder (ADHD) were randomly assigned to a treat-
Modrcin-McCarthy, McCue, and Walker (1997) used ment or a control group. Ninety-two fifth and sixth
the Roy Adaptation Model to develop a clinical tool grade students were assigned to the treatment or the
that may be used to identify actual and potential control group. Children in the treatment group
stressors of fragile premature infants and to imple- attended an eight-session, school nurse–led support
ment care for them. This tool measures signs of stress, group intervention (twice weekly for 4 weeks). The treat-
touch interventions, reduction of pain, environmen- ment was designed to teach the children about ADHD;
tal considerations, state, and stability (STRESS). the gifts of having ADHD, powerlessness versus