Callista Roy’s Adaptation Model

The work of Sr. Callista Roy covers over 40 years. From the early development of the model through the application of the model to nursing education, practice, and research, Roy and the adaptation model have touched the lives of many, personally, professionally, intellectually, and spiritually (Roy, 2009). As part of the Roy Adaptation Association core and one of the founding members, it is an honor to present the articles in this issue of Nursing Science Quarterly and write the editorial. Although the issue focuses on Roy, recognition needs to be given to Rosemarie Rizzo Parse, whose commitment and energy have maintained the dissemination of nursing models based research for decades through this journal.

Before writing this editorial, I re-read Susan Taylor’s editorial (2011) on Orem’s work in that special issue. What is so noteworthy is that much of Taylor’s description of Orem, is also true of the work of Callista Roy, as well as many of the other leading nurse theorists. My favorite quote is:

The thing that struck me was how prescient she was; her critical analysis of contemporary issues are equally as applicable to practice and education issues of today as they were in the 1960s when she began writing and speaking. Her distinction between levels of practice and levels of education, provide insights that are worthy of consideration today. Her work influenced nursing sciences, nursing practice and nursing education. (Taylor, 2011, p. 6)

It has been quite a few years since I led the application of the Roy adaptation model (RAM) for clinical practice in a neurosurgical unit in New York. Thinking back, there were a number of reasons that we decided upon the RAM and those reasons still hold true. A nursing model is certainly the way care needs to be structured. When using a model other than nursing, although helpful, the focus of integrated care is either lost or takes a back seat. For instance, the use of evidence-based practice has demonstrated some improvements in patient care, but it is more of a research strategy for approaching specific problems. A nursing model provides the nurse with a strategy to integrate the needs of the whole person, directing care to take into account the patient as a whole person.

The translation of a nursing model to hospital personnel is a challenge. In most healthcare systems, the medical model is used so the introduction of a nursing model is foreign. Hospitals and most clinics are organized according to medical specialties, in other words, the medical model. Imagine trying to explain how the unit nurses view patients to the medical staff. This is exactly what we had to do on the neurosurgical unit (Frederickson, 1993). For me, the challenge was made easier because I was implementing the RAM. The neurosurgical chief of the unit asked me to conduct rounds with the residents and medical students to present patients and explain the new approach that the nursing staff was now using. This approach to patient care was providing care based on identifying patients’ physiological and psychosocial needs. The first patient I presented was a young girl with a long history of seizures due to an arterio-venous malformation. One consideration was the role of her mother, a single parent, who had to organize her schedule around her daughter’s illness and the uncertainty of when the seizures would occur. The focus or focal stimulus for the lives of both the mother and daughter was on the seizures. I then explained the basics of the model and how viewing the patient as part of a family and how her physiological alteration had taken over the psychosocial experiences of their lives. Not only was the medical team able to understand the essence of the model but commented that this was something that they focused on. Whether or not the medical staff was in fact doing this is debatable, but their appreciation of the nurses’ perspective influenced how they viewed and interacted with the staff.

For me, the RAM has been an integral part of my life, personal and professional. Reflecting on the evolution of RAM based research, I returned to the publication of the first 25 years of RAM research (Boston Based Adaptation Research in Nursing Society, 1999). The early research that we reported (1970-1994) represented a first step and identified many problems with model-based research. The quality of research was often lacking and approximately 20% of the peer reviewed published articles were eliminated due to major methodological problems. In many cases, the model was used as an after-thought or represented an implicit rather than an explicit application. Of the journals with RAM-based research reports, only one represented an international journal. However, in reviewing current RAM research, including those in this issue, there is excellence in the methodological soundness of the research, the model is used as the organizing framework, there is a focus on international contributions as well as global collaborations; and, there are reports on programs of research and model-based instrument development. The four articles in this issue represent highlights of the progress made for model-based research.

Roy’s article in this issue addressed the extension of the model to meet nursing’s social mandate, given the nature of nursing and its globalization. Her focus on international nursing is evidenced by the new international RAM chapters, now in Mexico, Panama, Columbia, and Japan. When the tsunami and earthquake hit Japan, the United States Roy Adaptation Association reached out to those in the RAM organization in Japan.

To follow Roy’s article, Fawcett and co-authors presented the findings of a multisite international study on cesarean birth. Collaborating with nurse researchers from the United States, Finland, and Australia, Fawcett and colleagues demonstrated the value of international collaboration. Data revealed the positive effects of preparation for cesarean births across cultures through a very robust sample size.

Dobratz continues to build her program of research based on the RAM and on adaptation to death and dying. In this current article, she synthesized qualitative and quantitative studies to develop a series of testable hypotheses for a RAM-based middle-range theory on the psychological adaptation to end-of -life.

Lee and co-authors from Hong Kong reported on the development of an assessment instrument that they developed to determine the health needs of pregnant women. Their instrument uses the RAM four modes to measure antenatal adaptive behaviors.

This issue of Nursing Science Quarterly focuses on the RAM. Although the application of nursing practice using nursing conceptual models is sparse, the use by nurse researchers continues to increase. Long gone is the RAM on the neurosurgical unit, lacking supporters and an academic partnership. If the goal of nursing research is to improve nursing practice and nursing models are not used, what does that mean for the profession? A next step for nurse researchers is to understand and address the disconnect between nursing models in research and their lack of inclusion in nursing practice.