Using the Roy Adaptation Model to Guide Research and/or Practice ...

Jacqueline Fawcett1
Using the Roy Adaptation
Model to Guide Research
and/or Practice:
Construction of Conceptual-
Theoretical-Empirical
Systems of Knowledge
ABSTRACT
This paper presents an explanation of a three-step process for the use of a conceptual model to guide nursing research and/or prac-
tice. Step 1 involves learning the content of the conceptual model and its research and practice guidelines. Step 2 requires a review of
literature about the use of the model as a basis for research or practice. Step 3 focuses on construction and communication of a concep-
tual-theoretical-empirical structure for diverse research topics and practice situations. Emphasis is placed on application of the process
to one conceptual model of nursing: the Roy Adaptation Model.
KEY WORDS
Roy Adaptation Model, research, practice, nursing. (Source: DeCs, BIREME).
Recibido: 26 de agosto de 2009
Aceptado: 2 de noviembre de 2009
1 Professor, College of Nursing and Health Sciences. University of Massachusetts. Boston, USA. jacqueline.fawcett@umb.edu
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Uso del Modelo de Adaptación
de Roy para guía de la investigación
y/o la práctica: construcción de
sistemas de conocimiento
conceptuales-teóricos-empíricos
RESUMEN
Este artículo presenta una explicación para un proceso de tres pasos sobre el uso de un modelo conceptual para guía de la investiga-
ción y/o la práctica de la enfermería. El paso 1 implica el conocimiento del modelo conceptual y sus directrices para la investigación y la
práctica. El paso 2 exige una revisión de la literatura sobre el uso del modelo como base para la investigación o la práctica. El paso 3 se
enfoca en la construcción y la comunicación de una estructura conceptual – teórica – empírica sobre los diversos temas de investigación
y las situaciones de práctica. El énfasis se hace sobre la aplicación del proceso a un modelo conceptual de enfermería: el Modelo de
Adaptación de Roy.
PALABRAS CLAVE
Modelo de Adaptación de Roy, investigación, práctica, enfermería. (Fuente: DeCs, BIREME).
Aplicação do Modelo de Adaptação de
Roy na pesquisa o na prática:
construção de sistemas de conheci-
mento conceptual e teórico-empírico
RESUMO
Este artigo oferece uma explicação para um processo de três passos sobre o uso de um modelo conceitual para orientar a pesquisa
ou a prática de enfermagem. O passo 1 implica um conhecimento do modelo conceptual e suas diretrizes para a pesquisa e a prática. O
passo 2 requer uma revisão da literatura sobre a utilização do modelo como base para a investigação ou a prática. O passo 3 centra-se
na construção e a comunicação de um quadro conceptual e teórico-empírico sobre temas de investigação e várias situações de prática. A
ênfase está na aplicação do processo em um modelo conceitual de enfermagem: o Modelo de Adaptação de Roy.
PALAVRAS-CHAVE
Modelo de Adaptação de Roy, investigação, práctica, enfermagem. (Fonte: DeCs, BIREME).
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Using the Roy Adaptation Model to Guide Research and/or Practice: ... Jacqueline Fawcett
Introduction
The purpose of this paper is to present an explanation of three steps that need to
be followed to use a conceptual model to guide nursing research and/or practice. The
content of the paper reflects my belief that it is impossible to conduct nursing research or
to practice nursing without guidance from a conceptual model. Indeed, Popper (1) pointed
out that it is “absurd” (p. 46) to assume that development of any theory can occur without
guidance from a conceptual model. The paper content also reflects my beliefs that the
product of research always is a theory, and that nursing practice should be guided by
nursing theories that are derived from nursing conceptual models.
Steps to Follow to Use a Conceptual Model to
Guide Nursing Research and/or Practice
The use of a conceptual model to guide research and/or practice involves a process
made up of three steps (2). The three steps are listed here.
1. Develop a comprehensive understanding of the content and the research and practice
guidelines of the conceptual model.
2. Review existing research and practice guided by the conceptual model.
3. Construct and clearly communicate a conceptual-theoretical-empirical structure.
Step 1: Conceptual Model Content and Guidelines for Research and Practice
The first step of the process of using a conceptual model to guide nursing research
and/or practice is to understand the content of the conceptual model and to read care-
fully the guidelines for research and the guidelines for practice (2). A conceptual model is
made up of abstract and general concepts and statements about those concepts (3). The
content of the Roy Adaptation Model, for example, is made up of such abstract concepts
as environmental stimuli, coping processes, and modes of adaptation; the statements that
broadly define each concept; and the statements that link the concepts (see Figure 1). A
narrative summary of the Roy Adaptation Model is given in Box 1.
Figure 1. The Roy Adaptation Model
The content of the Roy
Adaptation Model, for
example, is made up of
such abstract concepts
as environmental
stimuli, coping
processes, and modes
of adaptation.
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Box 1. Narrative Summary of the Roy Adaptation Model
Within the context of the Roy Adaptation Model, individuals and groups are regarded
as adaptive systems whose behavior is a response to environmental stimuli (4). Roy (4)
identified three types of environmental stimuli--focal, contextual, and residual—that
she regards as constantly changing forces that affect individuals and groups. The focal
stimulus is the one most immediately confronting an individual or a group. The contex-
tual stimuli are all other stimuli that contribute directly to the individual’s or the group’s
responses. Residual stimuli are unknown factors that may be affecting the individual
or group. When a residual stimulus is identified, it usually becomes a contextual stimu-
lus but may turn out to be the focal stimulus.
Environmental stimuli are directly related to coping processes (4) and both directly
and indirectly related to the modes of adaptation (5). The indirect relation between
environment stimuli and the modes of adaptation is mediated by the coping processes
Individuals use two coping processes to filter environmental stimuli, which are called
the regulator and the cognator. The regulator coping process encompasses basic neu-
ral, chemical, and endocrine channels that process stimuli in an automatic, unconscious
manner. The cognator coping process encompasses four cognitive-emotive channels for
stimulus processing--perceptual/information processing, learning, judgment, and emo-
tion. Groups use two different coping processes to filter environmental stimuli, which
are called the stabilizer and the innovator. The stabilizer coping process facilitates
accomplishment of the purpose for which the group was formed, through use of the
group’s structure, values, and usual activities. The innovator coping process focuses
on the mechanisms by which the group changes and grows.
Roy (4) identified four modes of adaptation, which are the ways in which responses
to environmental stimuli are expressed in people’s behavior. The physiological mode
of adaptation incorporates individuals’ biological behaviors, such as vital signs and
clinical laboratory values. The physical mode of adaptation focuses on needs of the
group for the basic resources needed to function. The self-concept mode of adapta-
tion incorporates individuals’ feelings about their bodies and their personal selves.
The group identity mode of adaptation focuses on how the members of a group view
The purpose of Roy
themselves. The role function mode of adaptation draws attention to both individuals’
and groups’ performance of activities associated with the roles they enact in society.
Adaptation Model-
The interdependence mode of adaptation emphasizes interpersonal relationships and
the giving and receiving of social support.
guided research is to
Roy Adaptation Model-based nursing interventions involve management of the environ-
study the concepts and
mental stimuli. Roy (4) recommends focusing on managing the focal stimulus, taking
propositions of the
the contextual stimuli into account.
model, which requires
Fawcett (3) identified guidelines for
The purpose of Roy Adaptation Model-
both basic nursing
nursing research and guidelines for nurs-
guided research is to study the con-
ing practice based on the Roy Adaptation
cepts and propositions of the model,
research and clinical
Model. The guidelines for research are
which requires both basic nursing re-
nursing research.
listed here (3, pp. 385-396).
search and clinical nursing research.
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Using the Roy Adaptation Model to Guide Research and/or Practice: ... Jacqueline Fawcett
The purpose of basic nursing research
promote the ability of human adaptive
is to understand and explain people
systems to adjust effectively to chan-
adapting within their life situations.
ges in the environment and also to
The purpose of clinical research is
create changes in the environment.
to develop and test interventions and
other strategies designed to enhance

Practice problems of interest encom-
positive life processes and patterns.
pass adaptive and ineffective beha-
vioral responses of human adaptive

The phenomena of interest to Roy
systems in the physiological/physi-
Adaptation Model-guided research en-
cal, self-concept/ group identity, role
compass the content that is depicted
in Figure 1. The problems to be stu-
function, and interdependence adapti-
died include those stemming from the
ve modes.
attempts made by individuals to meet
their needs for physiological, psycho-

Nursing may be practiced in any set-
logical, spiritual, social, and relational
ting in which nurses encounter indivi-
integrity, as well as problems stem-
duals and groups, ranging from virtua-
ming from attempts made by groups
lly every type of health care institution
to meet their collective needs for re-
to people’s homes and the community
source adequacy, identity and relatio-
at large.
nal integrity, and role clarity.

Legitimate participants in nursing prac-

Participants in Roy Adaptation Model-
tice are human adaptive systems, in-
guided research may be individuals or
cluding individuals, families and other
groups who are well or who have acute
groups, communities, and society,
or chronic medical conditions. Appropria-
that are considered sick or well. Tho-
te research methods include qualitative
se adaptive systems may or may not
and quantitative descriptive, correlatio-
manifest specific adaptation problems
The third step in the
nal, and experimental research design.
and ineffective behavioral responses.
Data may be gathered in any health care
process of using a
setting in which human adaptive sys-

The nursing practice process is the
conceptual model to
tems are found. Research instruments
Roy Adaptation Model nursing process.
should reflect the unique focus and in-
The components of the process are
guide research and/
tent of the Roy Adaptation Model.
assessment of behavior, assessment
or practice requires
of stimuli, nursing diagnosis, goal set-

Data analysis techniques encompass
qualitative content analysis and nonpa-
ting, intervention, and evaluation.
the construction
rametric and parametric statistical pro-
of a conceptual-
cedures, with an emphasis on statisti-
Step 2: Review of Literature
cal techniques that facilitate analysis
The second step in the process of us-
theoretical-empirical
of nonlinear and reciprocal relations.
ing a conceptual model to guide research
and/or practice is to search and critically
(CTE) structure and
The guidelines for practice are listed
review the literature about the research
communication of that
here (3, p. 388).
topic or practice situation (2). The con-
cepts of the conceptual model can be used
structure in a diagram

The broad purpose of Roy Adaptation
as the basis for search terms and to cate-
Model–based nursing practice is to
gorize the results of the literature search.
and a narrative.
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The Cumulative Index to Nursing and Allied
and then categorized using the concepts
Health Literature (CINAHL) is an excellent
of the conceptual model. A worksheet that
electronic database for searches of litera-
can be used to organize literature about
ture about nursing conceptual models. For
the Roy Adaptation Model is shown in Ta-
example, a CINAHL search term is Roy Ad-
ble 1. An example of use of the worksheet
aptation Model. That search term can be
is given in Table 2.
combined with the search term, research,
Step 3: Construct and Communicate the
as well as with one or more search terms
Conceptual-Theoretical-Empirical Structure
that reflect the specific research topic or
practice situation. Suppose, for example,
The third step in the process of us-
you are interested in studying women’s
ing a conceptual model to guide research
responses to cesarean birth. Combining
and/or practice requires the construction
the search terms, Roy Adaptation Model,
of a conceptual-theoretical-empirical (CTE)
research, and cesarean, will yield relevant
structure and communication of that struc-
literature. Or, suppose you are interested
ture in a diagram and a narrative (2). The
in the postpartum care of women who
components of a CTE are the conceptual
have had a cesarean delivery. Literature
model (C) that is the basis for the research
that is relevant for this practice situation
topic or practice situation, the theory (T)
can be obtained by combining the search
that is to be generated or tested, and the
terms, Roy Adaptation Model, practice,
empirical indicators (E) that provide a way
postpartum, and cesarean.
to directly observe the theory.
Recall that the definition of a concep-
The citations to literature that are
tual model—the C component—is a set of
obtained from the search of the database
abstract and general concepts and state-
can be retrieved, reviewed for relevance,
ments about those concepts. The concepts
and statements that make up a conceptual
Table 1: Literature Search Worksheet for the Roy Adaptation Model
model are too broad to be used directly in
research or practice. Instead, theories—

Stimuli
Coping processes Modes of adaptation
Intervention
the T component - are derived from the con-

Author, date
Author, date
Author, date
Author, date
ceptual model and then are translated into
empirical indicators—the E component.

Author, date
Author, date
Author, date
Author, date

Author, date
Author, date
Author, date
Author, date
A theory is made up of relatively spe-
cific and concrete concepts and state-
Table 2: Example of Use of a Literature Search Worksheet for the Roy Adaptation Model
ments about the concepts (3). For ex-
ample, a theory of adaptation to cesarean
birth, which was derived from the Roy Ad-

Stimuli
Coping processes Modes of adaptation
Intervention
aptation Model, is made up of three con-

Bournaki, 1997
Baron & Roy, 1996 Gagliardi et al., 2002 Samarel et al. 1993,
cepts—type of cesarean birth (planned or



1997
unplanned), perception of the birth experi-

Samarel et al.,
Fawcett & Knauth,
Tsai et al., 2003
Mock et al., 1994
ence, and responses to cesarean birth, as
1993,
1997
1996
well as the definition of each concept and
three statements linking the concepts. The
Shin et al., 2006

Shin et al. 2006
Jirovec & Templin,
type of cesarean birth is directly related to



2001
responses to childbirth, perception of the
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Using the Roy Adaptation Model to Guide Research and/or Practice: ... Jacqueline Fawcett
birth experience is related to responses
as theory-testing research and practice
to cesarean birth, and the indirect relation
are essentially the same process, the CTE
between the type of cesarean birth and
structure is the same. This means that the
responses to cesarean birth is mediated
research process and the nursing practice
by perception of the birth experience (6).
process are equivalent processes (7). For
example, the statement of the problem in
An empirical indicator is a very con-
research is the same as the assessment
crete and specific substitute for a theory
phase of the nursing practice process, and
concept that allows the concept to be mea-
conduct of the research is the same as the
sured for research purposes or observed in
intervention phase of the nursing practice
practice situations (3). For example, percep-
process.
tion of the birth experience can be measured
by the Perception of Birth Experience Scale
Figure 2. Example of Theory-Generating
(POBES), and responses to cesarean birth
Research
can be measured by the Cesarean Birth
Experience Questionnaire (CBEQ). Many
empirical indicators, including the POBES
and the CBEQ, can be used as research in-
struments and as practice tools (7).
Inductive Reasoning:
Theory-Generating
Research
The CTE structure for theory-genera-
ting research is constructed inductively,
Figure 3. Example of Theory-Testing Research or Practice
proceeding from the conceptual model to
the empirical indicators to the theory. An
example of a CTE structure for a Roy Ad-
aptation Model-guided theory-generating
study is shown in Figure 2.
Deductive Reasoning:
Theory-Testing Research
and Practice
In contrast, the CTE structure for
theory-testing research and/or for prac-
tice is constructed deductively, proceeding
from the conceptual model to the theory to
the empirical indicators. An example of a
CTE structure for a Roy Adaptation Model-
guided theory-testing study or practice
situation is shown in Figure 3. Inasmuch
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Narrative Description of
Box 2. Narrative for the Conceptual-Theoretical-Empirical Structure Illustrated in Figure 2.
the CTE Structure
Figures 2 and 3 are diagrams of CTE
The Roy Adaptation Model concept of modes of adaptation guided construction of the
structures. The narrative that accompa-
nies the diagrams should clearly commu-
Cesarean Birth Experience Questionnaire (CBEQ). Content analysis of the data obtained
nicate what is illustrated in the diagram.
from study participants, who provided answers to the open-ended questions on the
Clear communication can be accomplished
CBEQ, revealed the Theory of Responses to Cesarean Birth. The Theory of Responses
by following the directions given here.
to Cesarean Birth is made up of the concept of cesarean birth responses, which is
For theory-generating research and
defined as physical feelings, feelings about self, feelings about delivering by cesarean
for theory-testing research and/or prac-
section, and feelings about the infant and other family members.
tice, follow these directions:

State the name of the conceptual model.
For theory-testing research and/or

Provide a narrative summary of the
practice, also follow these directions:
content of the conceptual model.

State the linkages between the con-
An example of the application of these
directions is seen in Box 1, which contains
ceptual model concepts and the theory
the name of a conceptual model – the Roy
concepts--Conceptual model concept
Adaptation Model in this example – and a
A is represented by theory concepta.
narrative summary of the content of that
Conceptual model concept B is repre-
conceptual model.
sented by theory conceptb. …Concep-
tual model conceptN is represented by
For theory-generating research, also
theory conceptn.
follow these directions:

Define each theory concept: -Concepta

State the linkage from the conceptual
is defined as …., Conceptb is defined
model to the empirical indicator--
as …., Conceptn is defined as ….
Conceptual model concept guided the
a
construction of Interview Schedulez.

State the linkages between the theory

State the linkages between the em-
concepts and the empirical indica-
pirical indicators and the theory
tors—Theory concepta will be mea-
concept(s)--Analysis of the data obtai-
sured by Empirical Indicatora, Theory
ned from study participants who res-
conceptb will be measured by Empi-
ponded to Interview Schedule revea-
z
rical Indicatorb, Theory conceptn will
led the Theory of X, which is made up
be measured by Empirical Indicatorn.
of the concept of A and its definition.
An example of the application of these

An example of the application of these
directions is seen in Box 2, which provides
directions is seen in Box 3, which pro-
the narrative for the CTE structure illus-
vides the narrative for the CTE struc-
trated in Figure 2.
ture illustrated in Figure 3.
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Using the Roy Adaptation Model to Guide Research and/or Practice: ... Jacqueline Fawcett
Box 3. Narrative for the Conceptual-Theoretical-Empirical Structure Illustrated in Figure 3.
The Roy Adaptation Model concept of environmental stimuli is represented by the theory
concept of type of cesarean birth, which is defined as planned or unplanned cesarean
delivery, as measured by an item on the Background Data Sheet.
The Roy Adaptation Model concept of the cognator coping processes is represented by
the theory concept of perception of the birth experience, defined as feelings about labor
or preoperative procedures, delivery, and initial contact with the infant, as measured by the
Perception of Birth Experience Scale.
The Roy Adaptation Model concept of modes of adaptation is represented by the theory
concept of responses to cesarean birth, which is defined as women’s responses to the
events surrounding cesarean childbirth, as measured by a numerical score based on
answers to open-ended questions on the Cesarean Birth Experience Questionnaire.
The Roy Adaptation
Model concept
Conclusion
of the cognator
When conceptual model guided theo-
The use of a conceptual model to guide
coping processes is
ry-testing research and/or practice are re-
nursing research and/or practice some-
garded as equivalent processes, the con-
times seems very complicated. However,
represented by the
tributions made by both researchers and
following the three-step process (Box 4)
theory concept of
practicing nurses to theory development
that is explained in this paper can simplify
become obvious. However, the contribu-
thinking about and communicating how
perception of the birth
tions will remain unrecognized if the work
you are using a conceptual model to guide
is not clearly communicated to others.
your research and/or practice.
experience, defined
as feelings about
Box 4. The Three-Step Process for Using a Conceptual Model to Guide Nursing Research
labor or preoperative
and/or Practice.
procedures, delivery,
Develop a comprehensive understanding of the content and the research and practice
and initial contact with
guidelines of the conceptual model.
the infant, as measured
Review existing research and practice guided by the conceptual model.
by the Perception of
Construct and clearly communicate a conceptual-theoretical-empirical structure.
Birth Experience Scale.
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