By Pia Orense ’15
In the 1960s and 1970s, Sister Callista Roy’s theory that “the goal of nursing is patient adaptation” was a revolutionary way of thinking. It changed the role of nurses from passive caretakers to critical decision makers who take a holistic view in healthcare. Her idea that people’s physiological needs and their environments affect a person’s coping processes became the foundation for the much acclaimed and now widely used Roy Adaptation Model. The Model provides a framework of looking at people as adaptive systems that will help nurses prioritize care. “It’s a lens through which you see a person not just as a sum of body systems but as a complex being in complex environments,” says Roy.
In an adaptive system, relationships and interactions affect a person’s feeling of security and emotional wellbeing. The patient’s social and cultural environments provide internal and external stimuli that trigger his or her coping mechanisms. The Model challenges the nurse to help the patient identify which coping strategies are more effective and “to move the patient from survival to transformation.”
Mount Magazine: It’s been more than three decades since you left the Mount for your post-doctoral research at UC San Francisco and to teach at Boston College. What is it like to be back on the campus where you started?
Sister Callista Roy: Well, it is just sheer joy. I’m really happy to be here. This is home. There’s so much of me here. I look down the hall and I see the faculty room where I developed the four adaptive modes. I was sorting all those 500 samples of patient behavior in that very room. This is where we did all the development of the Roy Adaptation Model. Why was I gone so long? I turned around and it’s been 35 years! I knew there was a time to come home and this seemed the right time. I had to return when I could still contribute. My life has been incredibly blessed and I think it’s just the providence of God the way that it worked out.
MM: The faculty and the students at the Mount were key players in the development of the Roy Adaptation Model. How did the process of developing the idea and the curriculum get started?
Roy: The beginning of it was when I was a master’s student in pediatrics at UCLA. It was the very early days of nursing knowledge development. It was 1964, a year after I had graduated from the Mount. That’s when I met Professor Dorothy Johnson, who said we had to develop our body of knowledge about nursing and to do that, we had to know clearly the goal of nursing. She asked us, ‘What are we trying to do as nurses?’ I had just read a small piece in a book about adaptation, and I thought, ‘Well, nursing’s all about that!’ So bold as anything, I just said, ‘Nursing is promoting patient adaptation.’ And she said, ‘What do you mean by that?’ So I got to spend my whole life explaining what I meant! After graduating, I came to the Mount to teach. The nursing faculty was very much ahead of their time — this was 1966. They were saying, ‘We want to redesign the curriculum but it should be based on a strong focus on nursing.’ I started talking about some of my ideas but they couldn’t care less! I mean, they taught me when I was an undergraduate (laughs). When I began teaching, I started using the ideas in my pediatric nursing class. I was looking at the goal of nursing as adaptation and designing a nursing care plan that listed patient behaviors and the stimuli affecting them.
But a strange thing happened at the end of my first year teaching. I had intense vertigo — it felt like I was in a centrifuge. It took 12 years for the diagnosis and the surgery because back then we didn’t have the proper diagnostic tools, no neuro imaging then. It turns out there was a small tumor growing on my balance nerve. That first year, I was bedridden and I had to be trained to get back on my feet. I came back a year later and the faculty said, ‘Now what were you saying a year ago?’ (laughs). So again, providence. I was developing some of the ideas on adaptation and one of them was assessing the processes of how people are coping. The faculty had their students collect for me samples of patient behavior. The pieces of paper asked, “When the patient needed a nurse, describe what was happening.” They were color coded by their clinical areas: maternity was pink, medical-surgical was blue, etc. So I had 500 samples of patient behavior and I was trying to figure out how we could categorize the whole patient, and if there were categories that were useful. And that’s how I came up with the four adaptive modes — from the information of the patients the students were taking care of. You know, later on, people said that in the early days of theory movement some of the nursing theories got very esoteric but they could always relate mine to practice. That’s because the Adaptation Model came from practice.
MM: What was it like in that room 50 years ago when you were sorting all those papers with patient examples?
Roy: I was thinking, ‘Oh my gosh, how is this ever going to make sense?’ But I knew it was going to work because it was very much my style. I do a lot of things publicly but I’m very introverted and I’m also very analytical. From the time I was a child people thought I needed glasses because it looked like I was squinting. No, I was just thinking! But those early days of the Model were a great adventure in the sense that I really believed in what we were doing. And working with the faculty was just wonderful. The work was reward in itself to a certain extent but then I had the privilege of having this incredible laboratory to try it out in, and it was amazing.
MM: Both the Adaptation Model and the Mount Wellness movement focus on the whole person’s wellbeing. How else does the wellness movement reflect the Model’s approach to health?
Roy: I think it is timely that Mount Wellness promotes eat green, move more, sleep well and de-stress to enhance holistic wellbeing. Our society needs this focus. The wellness movement and the use of the Roy Adaptation Model both provide strategies for continually moving toward health. Just as focusing on physiological needs, self-concept, role function and interdependence are intertwined, so the wellness strategies are intertwined. Each one and all together enhance physical, mental and spiritual health. Further, the use of the Roy model and the wellness movement empower individuals to take charge of their health.
MM: The Adaptation Model recently celebrated its 50th anniversary. How do you see the future of nursing education?
Roy: Right now there’s a huge push in the country to at least get all nurses baccalaureate-prepared. California is doing a great job and Mount Saint Mary’s has contributed to that immensely. More and more nurses are doing primary care, and soon our families will be dealing directly with nurses to keep healthy. The future of education has to do with providing more well-educated nurses who are going to be able to take on more complex roles and become leaders so that they can help shape the future of the healthcare system.
THE PAPER TRAIL
COLOR-CODED PAPER: The most important information in the development of the Roy Adaptation Model came from patient behavior samples collected by the Mount’s nursing students during their clinical experiences. Armed with color-coded sheets of paper (pink for maternity, yellow for pediatrics, blue for medical-surgical, green for psych and yellow for community), the students wrote down the reason for the visit: “What was the patient doing? What did the patient look like when needing nursing care?” All in all, Sister Callista Roy had 500 patient samples — written on paper smaller than an index card — to sort through. “It was intense, but I knew it was going to work,” Roy remembers of the days she spent holed up in a faculty room in the Humanities building on the Chalon Campus.
THREE-RING BINDERS: The “textbook” used during the first few years of the nursing program’s Adaptation Model-based curriculum was a large, black three-ring binder. “Every week or so, there would be another chapter for us to insert into our binder,” says Marsha Sato ’77. “Literally, the pages were hot off the press.” Once the curriculum was established and implemented in other schools, Mount faculty worked on producing the manuscript that would become the basis of the first book on the Model. The official textbook, “Introduction to Nursing: An Adaptation Model,” was published in 1976. Sato was later hired — by Roy herself, who was by then the chair of the nursing department — as a full-time instructor and contributed to the second edition of the textbook.
REPRINTS AND RESEARCH PAPERS: Since then, five major book revisions have been published and translations have been made in 15 languages. The Model has inspired more than 500 research publications and countless other research papers. The Roy Adaptation Association, established in 1991, now has seven international chapters. Roy continues to speak at conferences throughout the nation and across the globe.
Related story: Alums share their memories of Sr. Callista Roy and the early days of the Roy Adaptation Model.