1.

King’s General Systems Framework Nursing Conceptual Model

History and Background

In the mid-1960s, Imogene King wrote of the need for focus, organization, and use of a
nursing knowledge base (King, 1968). She proposed that knowledge for nursing
resulted from the systematic use and validation of knowledge about concepts relevant
to nursing situations. The use of knowledge in critical thinking results in decisions that
are implemented in professional nursing practice.
In 1971, King proposed a conceptual system for nursing around four concepts she
considered universal to the discipline of nursing: social systems, health, perception, and
interpersonal relationships. These areas were identified from the synthesis and
reformulation of concepts using inductive and deductive reasoning, critical thinking, and
extensive review of nursing and literature from other health-related disciplines.
Concepts were organized around individuals as personal systems, small groups as
interpersonal systems, and larger social systems such as community and school (King,
1971). Role, status, social organization, communication, information, and energy were
identified as basic concepts of functions of systems. King proposed that concepts were
interrelated and could be used across systems to identify the essence of nursing.

Overview of King’s Conceptual System and Theory of Goal Attainment

King’s conceptual system is based on the assumption that human beings are the focus
of nursing. The goal of nursing is health promotion, maintenance, and/or restoration;
care of the sick or injured; and care of the dying (King, 1992). King (1996) states that,
“nursing’s domain involves human beings, families, and communities as a framework
within which nurses make transactions in multiple environments with health as a goal”
(p. 61). The linkage between interactions and health is behavior, or human acts. Nurses
must have the knowledge and skill to observe and interpret behavior and intervene in
the behavioral realm to assist individuals and groups cope with health, illness, and crisis
(King, 1981). Concepts gleaned from an extensive review of the nursing literature
organize knowledge about individuals, groups, and society (King, 1971, 1992). King
notes that the concepts are often interrelated and can be applied across systems.
According to King (1981, 1988, 1991), concepts are critical because they provide
knowledge that is applicable to practice. Systems and concepts within King’s conceptual
system and Theory of Goal Attainment are described and defined in the following
section.
Major Concepts

PERSONAL SYSTEM
 Perception
 Self
 Growth and Development
 Body Image
 Time
 Personal Space
 Learning

Personal Systems
Individuals are personal systems (King, 1981). Each individual is an open, total, unique
system in constant interaction with the environment. Interactions between and among
personal systems are the focus of King’s conceptual system. Patients, family members,
friends, other health care professionals, clergy, and nurses are just a few examples of
individuals who interact in the nursing practice environment. The following concepts
provide foundational knowledge that contributes to understanding individuals as
personal systems:
• Perception: “A process of organizing, interpreting, and transforming information from
sense data and memory” (King, 1981, p. 24).
• Self: King (1981) cites developmental psychologist’s A. T. Jersild’s (1952) definition
of self when explaining that “knowledge of self is a key to understanding human
behavior because self is the way I define me to myself and to others. Self is all that I
am. I am a whole person. Self is what I think of me and what I am capable of being
and doing. Self is subjective in that it is what I think I should be or would like to be”
(p. 26). Self is a dynamic, action-oriented open system.
• Growth and development: “The processes that take place in an individual’s life that
help the individual move from potential capacity for achievement to self-
actualization” (King, 1981, p. 31).
• Body image: “An individual’s perceptions of his/her own body, others’ reactions to
his/her appearance which results from others’ reactions to self” (King, 1981, p. 33).
• Learning: “A process of sensory perception, conceptualization, and critical thinking
involving multiple experiences in which changes in concepts, skills, symbols, habits,
and values can be evaluated in observable behaviors and inferred from behavioral
manifestation” (King, 1986, p. 24).
• Time: “Duration between the occurrence of one event and occurrence of another
event” (King, 1981, p. 24).
• Personal space: “Existing in all directions and is the same everywhere” (King, 1981,
p. 37).
• Coping: King (1981) used the term coping in her discussion of the concept of stress
in the interpersonal system and in later discussions of the Theory of Goal Attainment
(King, 1992, 1997) without explicit definition.
INTERPERSONAL SYSTEM
 Interaction
 Communication
 Verbal Communication
 Nonverbal Communication
 Transaction
 Role
 Stress
 Coping

Interpersonal Systems
Interpersonal systems are formed by the interactions of two or more individuals (King,
1981). As the number of individuals increases, so does the complexity of the interaction.
These groups may range in size from two or three interacting individuals to small or
large groups. King’s process of nursing occurs primarily within the interpersonal
systems between the nurse and patient. Concepts critical to understanding interactions
between individuals are defined as follows:
• Communication: “Information processing, a change of information from one state to
another” (King, 1981, p. 69).
• Interaction: “Acts of two or more persons in mutual presence” (King, 1981, p. 85).
“The process of interactions between two or more individuals represents a sequence
of verbal and nonverbal behaviors that are goal-directed” (King, 1981, p. 60).
• Role: “Set of behaviors expected when occupying a position in a social system”
(King, 1981, p. 93).
• Stress: “Dynamic state whereby a human being interacts with the environment to
maintain balance for growth, development, and performance which involves an
exchange of energy and information between the person and the environment for
regulation and control of stressors” (King, 1981, p. 98).
• Stressors: Events that produce stress (King, 1981).
• Transaction: “Observable behaviors of human beings interacting with their
environment” (King, 1981, p. 147). “In the interactive process, two individuals
mutually identify goals and the means to achieve them. When they agree to the
means to implement the goals, they move toward transactions…. Transactions are
defined as goal attainment” (King, 1981, p. 61).

SOCIAL SYSTEM
 Organization
 Authority
 Power
 Status
 Decision Making
 Control

Social Systems
Social systems are composed of large groups with common interests or goals. A social
system is defined as “an organized boundary system of social roles, behaviors, and
practices developed to maintain values and the mechanisms to regulate the practice
and rules” (King, 1981, p. 115). Examples of social systems include health care
settings, workplaces, educational institutions, religious organizations, and families (King,
1981). Interactions with social systems influence individuals throughout the life span.
Concepts that are useful to understand interactions within social systems and between
social and personal systems are defined as follows:
• Organization: “A system whose continuous activities are conducted to achieve goals”
(King, 1981, p. 119).
• Authority: “Transactional process characterized by active, reciprocal relations in
which members’ values, backgrounds, and perceptions playa role in defining,
validating, and accepting the [directions] of individuals within an organization” (King,
1981, p. 124).
 • Power: “The capacity or ability of a group to achieve goals” (King, 1981, p. 124).
• Status: “The position of an individual in a group or a group in relation to other groups
in an organization” (King, 1981, p. 129).
• Decision making: “Dynamic and systematic process by which a goal-directed choice
of perceived alternatives is made, and acted upon, by individuals or groups to
answer a question and attain a goal” (King, 1981, p. 132).
King’s conceptual system provides both structure and function for nursing. Clearly
stated assumptions about persons, environment, health, nursing, and systems provide a
conceptual orientation of holism and dynamic interaction, specify health as the goal of
nursing, and actively include the patient (individual, family, or community) in decisions
about setting goals and the behavior necessary to achieve health goals.

Theory of Goal Attainment

The Theory of Goal Attainment addresses nursing as a process of human interaction.
Indeed, King (1981) stated that the Theory of Goal Attainment is a normative theory;
that is, it should set the standard of practice for all nurse-patient interactions. King
(1997) recalled finding an index card on which she had written the following 15 years
previously: “King’s law of nurse-patient interaction: Nurses and patients in mutual
presence, interacting purposefully, make transactions in nursing situations based on
each individual’s perceptions, purposeful communication, and valued goals” (p. 184).
The nurse and patient form an interpersonal system in which each affects the other
and in which both are affected by situational factors in the environment. Drawn from
both the personal and interpersonal system concepts, the Theory of Goal Attainment
comprises the concepts of perception, communication, interaction, transaction, self,
role, growth and development, stress/stressors, coping, time, and personal space. King
(1981, 1991) identified that perception, communication, and interaction are essential
elements in transaction. When transactions are made, goals are usually attained. The
human interaction and conceptual focus dimensions of the theory guide the nursing
process dimension (Figure 9-1).

FIGURE 9-1 Three-dimensional nursing process based on King’s Theory of Goal

Attainment. (Modified from Alligood, M. R. [1995]. Theory of goal attainment: Application
to adult orthopedic nursing. In M. A. Frey & C. L. Sieloff [Eds.], Advancing King’s
systems framework and theory of nursing [p. 212]. Thousand Oaks, CA: Sage.)
King demonstrated linkages between the Theory of Goal Attainment and the
traditional nursing process as shown in Table 9-1 (King, 1992). King (1993) viewed the
traditional nursing process as a system of interrelated actions—the method by which
nursing is practiced. In contrast, knowledge of the interrelated concepts in the Theory of
Goal Attainment (King, 1992) provides the theoretical basis for nursing practice. King
(1995b) underscored the importance of nursing process as both method and theory
when she stated, “Nurses are first, and foremost, human beings who perform their
functions in a professional role. It is the way in which nurses, in their role, do with and
for individuals that differentiates nursing from other health professionals” (p. 26). In this
way, King illustrated how “nursing theory serves to connect philosophical reflection with
nursing practice” (Whelton, 2008, p. 79).
TABLE 9-1
Nursing Process: Theory and Method

Nursing Process as Method∗ Nursing Process as Theory†

A system of interrelated actions A system of interrelated concepts

Assess Perception of nurse and client

  Communication of nurse and client

  Interaction of nurse and client

Plan Decision making about goals

  Agree to means to attain goals

Implement Transactions made

Evaluate Goal attained (if not, why not?)

∗
Yura, H., & Walsh, M. (1983). The nursing process. Norwalk, CT: Appleton-Century-
Crofts.
†
King, I. M. (1981). A theory for nursing: Systems, concepts, process. New York,
John Wiley (now published by Delmar, Albany, NY).
From King, I. M. (1992). King’s theory of goal attainment. Nursing Science Quarterly,
5(1), 23, with permission from Sage Publications.

Critical Thinking in Nursing Practice with King’s Conceptual System

It is generally agreed that critical thinking is knowing how to think, how to apply, how to
analyze, how to synthesize, and how to evaluate. Whereas the traditionalnursing
process of “assess, plan, implement, and evaluate” provides a method, the critical
thinking process emphasizes the intellectual skills of apprehension, judgment, and
reasoning.
Rubenfeld and Scheffer (1999) conducted a study to define critical thinking in nursing.
They formulated the following consensus statement to reflect the essence of critical
thinking in nursing:
Critical thinking in nursing is an essential component of professional accountability
and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind:
confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual
integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in
nursing practice the cognitive skills of analyzing, applying standards, discriminating
information seeking, logical reasoning, predicting, and transforming knowledge
(Rubenfeld & Scheffer, 1999, p. 5).
The development and use of critical thinking in nursing has received considerable
attention both in nursing education and in practice over the past two decades. However,
critical thinking has always been an integral component in King’s perspective of nursing.
In an early publication, Daubenmire and King (1973) presented a diagram (Figure 9-2)
titled “Methodology for the Study of Nursing Process.” Critical thinking is illustrated by
the use of terms such as analyze, synthesize, verify, and interpret. King explicitly linked
critical thinking to the mental acts of judgment that are implicit in perception,
communication, and interactions leading to transaction (King, 1992) and the concept of
decision making (King, 1999). Later, King (1999) added that ethical theories and
principles, along with the nursing process, had structured critical thinking and its
pedagogy in most nursing programs.

FIGURE 9-2 Methodology for the study of the nursing process. (From Daubenmire, M.

J., & King, I. M. [1973]. Nursing process: A system approach. Nursing Outlook, 21[8],
515.)
The delivery of nursing care to patients involves a process of thinking as well as
doing. In contrast to the traditional nursing process as a system of interrelated actions,
King’s perspective of the process reflects the science of nursing. Critical thinking
provides the rationale for actions taken by the nurse and serves as an excellent fit with
the premises of this text.
The following discussion illustrates critical thinking questions based on concepts
within King’s systems framework that are essential in carrying out activities of
assessing, planning, implementing, and evaluating.
At the first step of King’s process of nursing, the nurse meets the patient and
communicates and interacts with him or her. Assessment is conducted by gathering
data about the patient based on relevant concepts. The nurse considers the following
questions:
• What are the patient’s perceptions of the situation?
• What are my perceptions of the situation?
• What other information do I need to assist this patient to achieve health?
• What does this information mean to the situation?
• What conclusion (judgment) does the patient make?
• What conclusions (judgments) do I make?

INTERNAL ENVIRONMENT
EXTERNAL ENVIRONMENT
HEALTH
ILLNESS
NURSING PROCESS
 Perception
 Judgment
 Action
 Reaction
 Disturbance
 Mutual Goal Setting
 Exploration of Means to Achieve Goals
 Agreement on Means to Achieve Goals
 Transaction
 Attainment of Goals

Typology

Conceptual model of nursing

Brief Description

King’s Conceptual System, which also has been called the Open Systems Model, the
Interacting Systems Framework, the General Systems Framework, “focuses on the
continuing ability of individuals to meet their basic needs so that they may function in
their socially defined roles, as well as on individuals’ interactions within three open,
dynamic, interacting systems.” (Fawcett, J., & DeSanto-Madeya, S. (2013).
Contemporay nursing knowledge: Analysis and evaluation of nursing models and
theories (3rd ed., p. 81). Philadelphia, PA: F. A. Davis.)

Reference : https://nursekey.com/kings-conceptual-system-and-theory-of-goal-
attainment-in-nursing-practice/

2. Neuman’s Systems Model

Betty Neuman's System Model

This page was last updated on January 28, 2012

Betty Neuman's System Model

This page was last updated on January 28, 2012

INTRODUCTION
  Theorist - Betty Neuman - born in 1924, in
Lowel, Ohio.
 BS in nursing in 1957; MS in Mental Health
Public health consultation, from UCLA in 1966;
Ph.D. in clinical psychology
 Theory was publlished in:
o “A Model for Teaching Total Person
Approach to Patient Problems” in Nursing
Research - 1972.
o "Conceptual Models for Nursing
Practice", first edition in 1974, and
second edition in 1980.
 Betty Neuman’s system model provides a
comprehensive flexible holistic and system
based perspective for nursing.

DEVELOPMENT OF THE MODEL

Neuman’s model was influenced by:

 The philosophy writers deChardin and Cornu (on wholeness in system).

 Von Bertalanfy, and Lazlo on general system theory.
 Selye on stress theory.
 Lararus on stress and coping.

M A J O R C O N C E P T S  (Neuman, 2002)

Content

 the variables of the person in interaction with the internal and external
environment comprise the whole client system

Basic structure/Central core

 The common client survival factors in unique individual characteristics

representing basic system energy resources.
 The basis structure, or central core, is made up of the basic survival factors
which include: normal temp. range, genetic structure.- response pattern. organ
strength or weakness, ego structure.
 Stability, or homeostasis, occurs when the amount of energy that is available
exceeds that being used by the system.
 A homeostatic body system is constantly in a dynamic process of input, output,
feedback, and compensation, which leads to a state of balance.

Degree to reaction

 the amount of system instability resulting from stressor invasion of the normal
LOD.

Entropy

 a process of energy depletion and disorganization moving the system toward

illness or possible death.

Flexible LOD
  a protective, accordion like mechanism that surrounds and protects the normal
LOD from invasion by stressors.

Normal LOD

 It represents what the client has become over time, or the usual state of
wellness. It is considered dynamic because it can expand or contract over time. 

Line of Resistance-LOR

 The series of concentric circles that surrounds the basic structure.

 Protection factors activated when stressors have penetrated the normal LOD,
causing a reaction symptomatology. E.g. mobilization of WBC and activation of
immune system mechanism

Input- output

 The matter, energy, and information exchanged between client and environment
that is entering or leaving the system at any point in time.

Negentropy

 A process of energy conservation that increase organization and complexity,

moving the system toward stability or a higher degree of wellness.

Open system

 A system in which there is continuous flow of input and process, output and
feedback. It is a system of organized complexity where all elements are in
interaction.

Prevention as intervention

 Interventions modes for nursing action and determinants for entry of both client
and nurse in to health care system.

Reconstitution

 The return and maintenance of system stability, following treatment for stressor
reaction, which may result in a higher or lower level of wellness.

Stability

 A state of balance of harmony requiring energy exchanges as the client

adequately copes with stressors to retain, attain, or maintain an optimal level of
health thus preserving system integrity.

Stressors

 environmental factors, intra (emotion, feeling), inter (role expectation), and extra
personal (job or finance pressure) in nature, that have potential for disrupting
system stability.
 A stressor is any phenomenon that might penetrate both the F and N LOD,
resulting either a positive or negative outcome.

Wellness/Illness

 Wellness is the condition in which all system parts and subparts are in harmony
with the whole system of the client.
 Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman,
2002).
Prevention

 the primary nursing intervention.

 focuses on keeping stressors and the stress response from having a detrimental
effect on the body.

 Primary Prevention

o occurs before the system reacts to a stressor.

o strengthens the person (primary the flexible LOD) to enable him to better
deal with stressors
o includes health promotion and maintenance of wellness.

 Secondary Prevention

o occurs after the system reacts to a stressor and is provided in terms of

existing system.
o focuses on preventing damage to the central core by strengthening the
internal lines of resistance and/or removing the stressor.

 Tertiary Prevention
o occurs after the system has been treated through secondary prevention
strategies.
o offers support to the client and attempts to add energy to the system or
reduce energy needed in order to facilitate reconstitution.

FOUR NURSING PARADIGMS

PERSON

 Human being is a total person as a client system and the person is a layered
multidimensional being.
 Each layer consists of five person variable or subsystems:
o Physiological - Refers of the physicochemical structure and function of
the body.
o Psychological - Refers to mental processes and emotions.
o Socio-cultural - Refers to relationships and social/cultural expectations
and activities.
o Spiritual - Refers to the influence of spiritual beliefs.
o Developmental - Refers to those processes related to development over
the lifespan.

ENVIRONMENT

 "the totality of the internal and external forces (intrapersonal, interpersonal and
extra-personal stressors) which surround a person and with which they interact at
any given time."
 The internal environment exists within the client system.
 The external environment exists outside the client system.
 The created environment is an environment that is created and developed
unconsciously by the client and is symbolic of system wholeness.

HEALTH

 Health is equated with wellness.

 “the condition in which all parts and subparts (variables) are in harmony with the
whole of the client (Neuman, 1995)”.
 The client system moves toward illness and death when more energy is needed
than is available. The client system moved toward wellness when more energy is
available than is needed
NURSING

 a unique profession that is concerned with all of the variables which influence the
response a person might have to a stressor.
 person is seen as a whole, and it is the task of nursing to address the whole
person.
 Neuman defines nursing as “action which assist individuals, families and groups
to maintain a maximum level of wellness, and the primary aim is stability of the
patient/client system, through nursing interventions to reduce stressors.’’
 The role of the nurse is seen in terms of degree of reaction to stressors, and the
use of primary, secondary and tertiary interventions.

NEUMAN'S MODEL & CHRACTERISTICS

 interrelated concepts
 logically consistent.
 logical sequence
 fairly simple and straightforward in approach.
 easily identifiable definitions
 provided guidelines for nursing education and practice
 applicable in the practice

Research Articles

1. “Using the Neuman Systems Model for Best Practices’’--Sharon A. DeWan, Pearl
N. Ume-Nwagbo, Nursing Science Quarterly, Vol. 19, No. 1, 31-35 (2006).
2. Melton L, Secrest J, Chien A, Andersen B.    “A community needs assessment
for a SANE program using Neuman's model”  J Am Acad Nurse Pract. 2001
Apr;13(4):178-86.

CONCLUSION

 Betty Neuman’s system model provides a comprehensive flexible holistic and

system based perspective for nursing.
 Neuman's model focuses on the response of the client system to actual or
potential environmental stressors and the use of primary, secondary and tertiary
nursing prevention intervention for retention, attainment, and maintenance of
optimal client system wellness.

REFERENCES

1. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW,
NY.
2. George B. Julia , Nursing Theories- The base for professional Nursing Practice ,
3rd ed. Norwalk, Appleton and Lange.
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing
Philadelphia. Lippincott Williams& wilkins.
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd
ed. Philadelphia,  Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed.
Philadelphia,  Lippincott.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts
Process & Practice 3rd ed. London Mosby Year Book.
7. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing
theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006
Jul;19(3):225
9. Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd
edition, Thomson, NY, 2002

Reference: http://currentnursing.com/nursing_theory/Neuman.html
 3. Roy’s Adaptation Model

Biography of Callista Roy

Sister Callista L. Roy (born October 14, 1939) is a nursing theorist, profession, and
author. She is known for her groundbreaking work in creating the Adaptation Model of
Nursing.

Adaptation Model of Nursing

Sr. Callista Roy’s Adaptation Model of Nursing was developed by Sister Callista Roy in
1976. The prominent nursing theory aims to explain or define the provision of nursing. In
her theory, Roy’s model sees the individual as a set of interrelated systems who strives
to maintain balance between these various stimuli. Adaptation Model of Nursing is
discussed further below.

Callista Roy’s Adaptation Model of Nursing

The Adaptation Model of Nursing is a prominent nursing theory aiming to explain or

define the provision of nursing science. In her theory, Sister Callista Roy’s model sees
the individual as a set of interrelated systems who strives to maintain a balance
between various stimuli.

The Roy Adaptation Model was first presented in the literature in an article published
in Nursing Outlook in 1970 entitled “Adaptation: A Conceptual Framework for
Nursing.” In the same year, Roy’s Adaptation Model of Nursing was adapted in Mount
St. Mary’s School in Los Angeles, California.

Roy’s model was conceived when nursing theorist Dorothy Johnson challenged her

students during a seminar to develop conceptual models of nursing. Johnson’s nursing
model was the impetus for the development of Roy’s Adaptation Model.

Roy’s model incorporated concepts from Adaptation-level Theory of Perception from

renown American physiological psychologist Harry Helson, Ludwig von Bertalanffy’s
System Model, and Anatol Rapoport’s system definition.

First, consider the concept of a system as applied to an individual. Roy conceptualizes

the person in a holistic perspective. Individual aspects of parts act together to form a
unified being. Additionally, as living systems, persons are in constant interaction with
their environments. Between the system and the environment occurs an exchange of
information, matter, and energy. Characteristics of a system include inputs, outputs,
controls, and feedback.

Major Concepts of the Adaptation Model

The following are the major concepts of Callista Roy’s Adaptation Model including the
definition of the nursing metaparadigm as defined by the theory.

Person

“Human systems have thinking and feeling capacities, rooted in consciousness and
meaning, by which they adjust effectively to changes in the environment and, in turn,
affect the environment.”

Based on Roy, humans are holistic beings that are in constant interaction with their
environment. Humans use a system of adaptation, both innate and acquired, to respond
to the environmental stimuli they experience. Human systems can be individuals or
groups, such as families, organizations, and the whole global community.

Environment

“The conditions, circumstances and influences surrounding and affecting the

development and behavior of persons or groups, with particular consideration of the
mutuality of person and health resources that includes focal, contextual and residual
stimuli.”

The environment is defined as conditions, circumstances, and influences that affect the
development and behavior of humans as an adaptive system. The environment is a
stimulus or input that requires a person to adapt. These stimuli can be positive or
negative.

Roy categorized these stimuli as focal, contextual, and residual. Focal stimuli are that
which confronts the human system and requires the most attention. Contextual
stimuli are characterized as the rest of the stimuli that present with the focal stimuli and
contribute to its effect. Residual stimuli are the additional environmental factors
present within the situation, but whose effect is unclear. This can include previous
experience with certain stimuli.
Health

“Health is not freedom from the inevitability of death, disease, unhappiness, and stress,
but the ability to cope with them in a competent way.”

Health is defined as the state where humans can continually adapt to stimuli. Because
illness is a part of life, health is the result of a process where health and illness can
coexist. If a human can continue to adapt holistically, they will be able to maintain health
to reach completeness and unity within themselves. If they cannot adapt accordingly,
the integrity of the person can be affected negatively.

Nursing

“[The goal of nursing is] the promotion of adaptation for individuals and groups in each
of the four adaptive modes, thus contributing to health, quality of life, and dying with
dignity.”

In Adaptation Model, nurses are facilitators of adaptation. They assess the patient’s
behaviors for adaptation, promote positive adaptation by enhancing environment
interactions and helping patients react positively to stimuli. Nurses eliminate ineffective
coping mechanisms and eventually lead to better outcomes.

Adaptation

Adaptation is the “process and outcome whereby thinking and feeling persons as
individuals or in groups use conscious awareness and choice to create human and
environmental integration.”

Internal Processes

Regulator

The regulator subsystem is a person’s physiological coping mechanism. It’s the

body’s attempt to adapt via regulation of our bodily processes, including neurochemical,
and endocrine systems.

Cognator

The cognator subsystem is a person’s mental coping mechanism. A person uses

his brain to cope via self-concept, interdependence, and role function adaptive modes.

Four Adaptive Modes

The four adaptive modes of the subsystem are how the regulator and cognator
mechanisms are manifested; in other words, they are the external expressions of the
above and internal processes.

Physiological-Physical Mode

Physical and chemical processes involved in the function and activities of living
organisms. These are the actual processes put in motion by the regulator subsystem.

The basic need of this mode is composed of the needs associated with oxygenation,
nutrition, elimination, activity and rest, and protection. The complex processes of this
mode are associated with the senses, fluid and electrolytes, neurologic function, and
endocrine function.

Self-Concept Group Identity Mode

In this mode, the goal of coping is to have a sense of unity, meaning the purposefulness
in the universe, as well as a sense of identity integrity. This includes body image and
self-ideals.

Role Function Mode

This mode focuses on the primary, secondary and tertiary roles that a person occupies
in society, and knowing where he or she stands as a member of society.

Interdependence Mode

This mode focuses on attaining relational integrity through the giving and receiving of
love, respect and value. This is achieved with effective communication and relations.

Levels of Adaptation

Integrated Process

The various modes and subsystems meet the needs of the environment. These are
usually stable processes (e.g., breathing, spiritual realization, successful relationship).
Compensatory Process

The cognator and regulator are challenged by the needs of the environment, but are
working to meet the needs (e.g., grief, starting with a new job, compensatory breathing).

Compromised Process

The modes and subsystems are not adequately meeting the environmental challenge
(e.g., hypoxia, unresolved loss, abusive relationships).

Six-Step Nursing Process

A nurse’s role in the Adaptation Model is to manipulate stimuli by removing, decreasing,

increasing or altering stimuli so that the patient

1. Assess the behaviors manifested from the four adaptive modes.

2. Assess the stimuli, categorize them as focal, contextual, or residual.
3. Make a statement or nursing diagnosis of the person’s adaptive state.
4. Set a goal to promote adaptation.
5. Implement interventions aimed at managing the stimuli.
6. Evaluate whether the adaptive goal has been met.

Analysis

As one of the weaknesses of the theory that application of it is time-consuming,

application of the model to emergency situations requiring quick action is difficult to
complete. The individual might have completed the whole adaptation process without
the benefit of having a complete assessment for thorough nursing interventions.

Adaptive responses may vary in every individual and may take a longer time compared
to others. Thus, the span of control of nurses may be impeded by the time of the
discharge of the patient.

Unlike Levine, although the latter tackled on adaptation, Roy gave much focus on the
whole adaptive system itself. Each concept was linked with the coping mechanisms of
every individual in the process of adapting.

The nurses’ roles when an individual presents an ineffective response during his or her
adaptation process were not clearly discussed. The main point of the concept was to
promote adaptation but none were stated on how to prevent and resolve maladaptation.

Strengths of the Roy’s Adaptation Model

 The Adaptation Model of Callista Roy suggests the influence of multiple

causes in a situation, which is a strength when dealing with multi-faceted
human beings.
 The sequence of concepts in Roy’s model follows logically. In the presentation
of each of the key concepts, there is the recurring idea of adaptation to
maintain integrity. Every concept was operationally defined.
 The concepts of Roy’s model are stated in relatively simple terms.
 A major strength of the model is that it guides nurses to use observation and
interviewing skills in doing an individualized assessment of each person.The
 concepts of Roy’s model are applicable within many practice settings of
nursing.

Weaknesses

 Painstaking application of the model requires significant input of time and

effort.
 Roy’s model has many elements, systems, structures and multiple concepts.

See Also

You may also like the following nursing theories study guides: 

 Nursing Theories and Theorists – The Ultimate Nursing Theories and

Theorists Guide for Nurses.

References

1. Wills M. Evelyn, McEwen Melanie (2002). Theoretical Basis for

Nursing. Philadelphia. Lippincott Williams & Wilkins.
2. Andrew, H.A. and Roy, C. (1991). Overview of the physiologic mode. In
George, J. (Ed.). Nursing theories: the base for professional nursing
practice. Norwalk, Connecticut: Appleton & Lange.
3. Roy, C. and McLeod, D. (1981) The theory of the person as an adaptive system.
In George, J. (Ed.). Nursing theories: the base for professional nursing
practice. Norwalk, Connecticut: Appleton & Lange.
4. Roy, C. and Adrews, H. A. (1999). The Roy adaptation model (2nd ed). In
McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott
Williams & Wilkins.

Reference: https://nurseslabs.com/sister-callista-roys-adaptation-model/