Works and Theories of Callista Roy

Callista Roy is an extremely important figure in both nursing and philosophy. Her nursing theories have paved the way for a number of nursing advances. This is largely because of the practical application of her nursing theories, which allow for a great deal of testing and real-world application. It is important to apply Roy's concepts of nursing theory to real-world scenarios. There are a number of viable reasons for this, but perhaps the most prevalent of these is simply that it allows these real-world problems to be approached in a new way, while also testing the practicality of specific nursing theories in a real-life scenario. For this specific paper, the nursing theory that will be examined is Callista Roy's Adaptation Model of Nursing, which Roy herself actually invented and discussed at length.

The Adaptation Model of Nursing, which was invented by Callista Roy, focuses on the individual (although this individual may also symbolize a group of people) and their internal struggles and issues, and how they themselves are struggling to maintain a state of homeostasis, or balance, within their lives.2 The Adaptation Model of Nursing also contains a number of more abstract ideas concerning both diagnosis and treatment of problems in patients and tends to be a broad yet very practical nursing theory. The Adaptation Model of Nursing also sees adaptation as a constant, driving force for the survival of both the individual and the group, and that, in order to overcome illness, disease, injury, or other hardship, adapting and limiting the effect of these negative symptoms is of the utmost priority for both individuals and groups. 3 Furthermore, the Adaptation Model of Nursing theory utilizes four modes to achieve this homeostasis: the self-concept mode, role function mode, interdependence mode, and physiological mode.4 To properly utilize these four modes, the Adaptation Model of Nursing must use a six-step process in order to diagnose and treat any sort of problem within an individual or group. The first step is the assessment of behavior, where a person is exposed to each of the four different modes, and their reactions and behaviors to these modes observed and noted to determine if anything is out of the ordinary.5 The second step is similar, assessment of stimuli, and focuses on understanding the stimuli at work within an individual while also classifying these stimuli as either contextual, residual, or focal.6 The third step is the nursing diagnosis, which is simply the statement about the cause of the grief or imbalance within an individual or group and what unnatural behaviors led to that conclusion.7 The fourth step, goal setting, is the act of finding a realistic goal that the person can agree with and strive to achieve. If a goal is too lofty, the person likely cannot achieve it, but if the goal is not lofty enough, the person will not change enough to make a significant difference.8 The fifth stage is where the action happens, and is referred to as the "doing phase," which is where the person or group actually begin manipulating the negative stimuli around them that are causing them grief in an attempt to better their situation.9 Finally, the sixth step is the evaluation of the progress that had been made and how much change, if any, has been made throughout the numerous trials and studies, which helps to determine if further studies or measures are required, and what behaviors are more prominent after testing than before testing. 10 Using these six steps, it is possible to find an adaptive yet practical solution to many problems facing the world of nursing today.

Roy's Adaptation Model of Nursing theory differs greatly from many other nursing theorists in the field. One of the most striking comparisons comes from comparing Roy's Adaptation Model of Nursing theory to the other categories of nursing theories: grand nursing theories, and mid-range nursing theories, with the grand nursing theories having the broadest scope of application, and the mid-range offering a moderate scope of application. 11 One model of nursing that is vastly different than Roy's Adaptation Model of Nursing is Myra Levine's Conservation Model. Essentially, the Conservation Model of nursing focuses much more on objective criterion, oftentimes involving the client themselves as the most crucial aspect of the model.12 The Conservation Model of nursing contains a number of key concepts, all of which involve conservation to some capacity. One of these is perhaps the most well-known conservation theory: the conservation of energy. This concept simply mandates that the client should use as little energy as possible through rest and exercise, but enough to accomplish the ultimate goal of recovery.13 Another of these conservation key concepts is less material and is known as conservation of personal integrity. This concept states that the nurse should help his or her clients to maintain their individuality via whatever means are necessary, oftentimes through occasional bonding sessions.14 These key concepts differ from Roy's Adaptation Model of Nursing simply because Roy's model does not focus so much on conservation in general, instead opting to place more emphasis on the internal, objective recovery of the client via observable traits, both physical and psychological, within the client. In that sense, Roy's Adaptation Model of Nursing has a much more practical application than Levine's conservation model, which almost acts more like guidelines than actual, applicable theories. The greatest weakness of Levine's theory is that it is too focused on the comfort and satisfaction of the client. Essentially, her theory is too dependent upon the removal of symptoms, not necessarily the removal of the underlying problem itself. However, these two nursing theories do share a few common elements. For instance, they both focus a great deal on the client themselves, rather than some sort of bigger picture or loftier goal. Furthermore, both nursing theories involve the utilization of a step-by-step process in finding and eliminating symptoms. Levine's model involves, in order, assessment, judgment, hypotheses, interventions, and evaluation, in order to diagnose and treat problems and symptoms with clients. 15

Nursing theories tend to have different categories and focuses on either practical application or theoretical application. 16 This means that each nursing theory has specific fields and applications that fit it best. For example, the System and Diffusion Innovation Theories are similar, yet are utilized in completely different capacities. This helps to differentiate each nursing theory from one another much more clearly. For example, another theory that clashes in many ways with Roy's nursing theory is what is known as the Behavioral System Model, created by Dorothy Johnson.17 Johnson's theory is focused largely on the individual, although not, as with the case of Levine's theory, the mere treatment of symptoms and comfort, but recovery of the individual in general, with a focus on the person, rather than the disease.18 This nursing theory, like the other two examined, incorporates a number of what are known as "core principles:" wholeness and order, stabilization, reorganization, hierarchic interaction, and dialectical contradiction.19 The wholeness and order section of Johnson's theory, for example, focuses on the continuity and identity of the patient themselves, which is similar to Levine's model of nursing but decidedly different from Roy's, who does not focus as largely on the individual. 20 Johnson's model also focuses largely on what she refers to as subsystems of behavior, such as the achievement subsystem, which offers the goal of master or control of self or the environment, or the affiliative subsystem, with the ultimate goal of relating or belonging to someone or something other than oneself.21As is evidenced here, Johnson's model is focused firmly on the psychological recovery of the patient, with the overriding belief that physical recovery (and thus, comfort) will follow, whereas Roy's model is firmly planted in practicality and focuses on clear, observable, yet consistent recovery within the patient. For this reason, Roy's theory is much more suitable for a grander, longer recovery period, while models such as Johnson's focus on more immediate recovery from, for example, some form of painful accident.

Another way to gauge the effectiveness of Roy's model is to examine its effects on the patients themselves. Roy's Adaptation Model of Nursing theory is renowned for its practical benefits, and nowhere is this more apparent than with physical therapy patients, which is, in and of itself, a very practical subset of nursing. One key reason that Roy's model works so well with physical therapy patients is that, according to one study, the field is undergoing a state of rapid change, and has been for many years. 22 This means that having a nursing theory that is firmly grounded in reality and practical application is crucial, as it will allow the field of physical therapy to progress and evolve smoothly, without having to have its own internal philosophies changed every time there is a major transition, technologically or otherwise. Furthermore, Roy's Adaptation Model of Nursing theory, in and of itself, focuses largely on adaptation of the patient. 23 This focus on change, which is one of the few principles that can be relied upon consistently, helps to "future-proof" the field of physical therapy by focusing on adaptation itself, so that practitioners may focus more on results and other concrete benefits, rather than somewhat arbitrary concepts such as comfort. Another aspect of physical therapy is that it requires a great deal of problem-solving skills, and this is complimented perfectly by the Adaptation Model of Nursing theory. 24 This emphasis on problem-solving skills is mirrored by Roy's persistence in diagnosing more difficult-to-find symptoms, such as the observation of numerous types of stimuli and their effects on the patient.25 The benefits of Roy's Adaptation Model of Nursing also extend to the families of the patients because Roy's model can be used to assess families via a multi-step process that is very similar to her process of diagnosing problems in individual patients. 26 For example, Roy's model examines the numerous adaptation modes within a family, such as the Interdependence mode, which asks the extent upon which family members rely on one another, are allowed to be independent, and their openness to assistance from members outside of the family.27

This process of applying a specific nursing theory to a real-life scenario helped to clarify just how these nursing theories actually function in practice. This also shows that nursing theories can be applied to much more than purely nursing-related subjects and fields. Roy's Adaptation Model of Nursing is perfect for application to non-nursing problems because it is so focused on the impacts of those affected, rather than being sidetracked by philosophical or ethical questions. Furthermore, the Adaptation Model of Nursing follows a very strict guideline and allows for a great deal of intervention by the person overseeing the particular study so that the situation is never out of the overseer's control. The Adaptation Model of Nursing also categorizes many things that would be considered subjective or abstract by many, such as the numerous types of stimuli, or the usage of four different modes, which measure, among other things, quality of life.

References

1,2,23,25,27 Roy, Callista. "Future of the Roy model: Challenge to Redefine Adaptation." Nursing Science Quarterly 10.1 (1997): 42-48.

3,4,5,6,7,8,9,10 Meleis, Afaf Ibrahim. Theoretical nursing: development and progress. Lippincott Williams & Wilkins, 2011. 326-328

11,12,13,14,15,17,18,19,20,21,26 Parker, Marilyn E., and Marlaine C. Smith. Nursing theories & nursing practice. FA Davis, 2010. 10,

16 Fawcett, Jacqueline, et al. "On nursing theories and evidence." Journal of Nursing Scholarship 33.2 (2001): 115-119.

22,24Jensen, Gail M., et al. "Expert practice in physical therapy." Physical therapy 80.1 (2000): 28-43.