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CHAPTER 17 Sister Callista Roy 319

role function, and interdependence. Roy recently has Rather than a system acting to maintain itself, the em-
redefined health, deemphasizing the concept of phasis shifts to the purposefulness of human existence in
a health-illness continuum and conceptualizing health a universe that is creative” (Roy & Andrews, 1999, p. 35).
as integration and wholeness of the person. This Roy has written that other disciplines focus on an
approach more clearly incorporates the adaptive aspect of the person, and that nursing views the person
mechanisms of the comatose patient in response to as a whole (Roy & Andrews, 1999). “Based on the
tactile and verbal stimuli. However, because health philosophic assumptions of the nursing model, persons
was not conceptualized in this manner in the earlier are seen as coextensive with their physical and social
work, this opens up a new area for research. Based on environments. The nurse takes a values-based stance,
her integrative review of the literature, Frederickson focusing on awareness, enlightenment and faith” (Roy
(2000) concluded that there is good empirical support & Andrews, 1999, p. 539). Roy contends that persons
for Roy’s conceptualization of person and health. She have mutual, integral, and simultaneous relationships
made the following recommendations for future with the universe and God, and that as humans they
research. First, there is a need to design studies to test “use their creative abilities of awareness, enlightenment,
propositions related to environment and nursing. Sec- and faith in the processes of deriving, sustaining, and
ond, interventions based on previously supported transforming the universe” (Roy & Andrews, 1999,
concepts and propositions have been tested, while p. 35). Using these creative abilities, persons (sick or
others remain for testing to document evidence. well) are active participants in their care and are able to
achieve a higher level of adaptation (health).
Critique Mastal and Hammond (1980) discussed difficul-
ties with Roy’s model in classifying certain behaviors
Clarity because concept definitions overlapped. The prob-
The metaparadigm concepts of the Roy Adaptation lem dealt with theory conceptualization and the
Model (person, environment, nursing, and health) are need for mutually exclusive categories to classify
clearly defined and consistent. Roy clearly defines the human behavior. Conceptualizing a person’s posi-
four adaptive modes (physiological, self-concept, tion on the health-illness continuum is no longer a
interdependence, and role function). A challenge of problem because Roy redefined health as personal
the model that was identified is Roy’s espousal of a integration. Other researchers have referred to diffi-
holistic view of the person and environment, while culty in classifying behavior exclusively in one adap-
the model views adaptation as occurring in four tive mode (Bradley & Williams, 1990; Limandri,
adaptive modes, and person and environment are 1986; Nyqvist & Sjoden, 1993; Silva, 1987). However,
conceptualized as two separate entities, with one this observation supports Roy’s proposition that
affecting the other (Malinski, 2000). An answer to this behavior in one adaptive mode affects and is affected
challenge is that Roy’s adaptation model is holistic, by the other modes.
since change in the internal or external environment
(stimulus) leads to response (adapts) as a whole. Simplicity
In fact, Roy’s perspective is consistent with other The Roy model includes the concepts of nursing, per-
holistic theories, such as psychoneuroimmunology son, health-illness, environment, adaptation, and
and psychoneuroendocrinology. As one example, nursing activities. It also includes two subconcepts
psychoneuroimmunology is a theory that proposes (regulator and cognator) and four modes (physiologi-
a bidirectional relationship between the mind and cal, self-concept, role function, and interdependence).
the immune system. Roy’s model is broader than psy- This model has several major concepts and subcon-
choneuroimmunology and provides a theoretical cepts, so the relational statements are complex until
foundation for research about, and nursing care of, the model is learned.
the person as a whole.
In more recent writings, Roy has acknowledged the Generality
holistic nature of persons who live in a universe that is The Roy Adaptation Model’s broad scope is an advan-
“progressing in structure, organization, and complexity. tage because it may be used for theory building and