Nursing Theory Analysis Paper

Nursing Theory Analysis Paper


Every discipline has a distinct focus for the development of knowledge that distinguishes it from other disciplines of study and directs its inquiry. The knowledge which makes up the discipline has some form of organization. Understanding this structure or organization of the discipline is essential especially for those people involved in learning the discipline’s theories, as well as, for those that are seeking to develop knowledge and expand the discipline (Elcock, 2010). Probably, this need is vital in the field of nursing since the evolution of the specialized practice founded on knowledge from other disciplines and tradition preceded evolution of substantive knowledge of the field.  Knowledge in nursing is the comprehensive whole of the theories, philosophies, practice, and research of the discipline. As a professional discipline, the knowledge is exceedingly vital for guiding practice in the field.  Evidence-based and theory guided practice is the characteristic of any professional discipline. The main purpose of this paper, therefore, is to explore one middle range theory of the nursing field in order to have a clear understanding of the discipline and reestablish a context for understanding the concepts of the field (Elcock, 2010). The paper seeks to describe the theorist associated with the theory in detail and discusses how the theorist’s experiences have impacted on development of theory. It examines important references for both the original and current work of the theorist on the chosen theory and identifies the phenomenon of concern or issues that the theory addresses. The usefulness of the theory in research and practice of nursing will also be addressed.

Middle range theories

Middle range theories are focused on measurable pieces of reality rather than on universal world as in the case of grand theories (Jim, 2010). These include social mobility, role conflict, deviance, interdependence of social institutions, deviance, self-transcendence, community empowerment, uncertainty in illness, symptom management, unpleasant symptoms, self-efficacy, story, family stress and adaptation, care giving dynamics, cultural marginality, meaning, moral reckoning, normalization processes, reference groups theory among others. Specifically, the essay explains the theory of adaptation by Roy. This theory has been expanded through development of other theories as later discussed in the paper.

Adaptation Theory

During the beginning of the 21st century, Watson declared that the survival of nursing as a profession was at stake during that moment. Watson went on and issued a call for nursing to reevaluate the cause for this, as well as, its core existence. The researcher also wanted to reassess whether the cause was sufficiently grounded to survive in the face of contemporary healthcare. Roy’s Adaptation Model offers the required basis for survival of the nursing discipline (Naga & Al-Atiyyat, 2013). This theory of nursing that was initially presented around 35 years ago has continued to be used by nurses and other health care givers in many regions across the world as a guide for practice, education, research, and administration services in the nursing field.

When the theory or model is used as a guide for these activities in nursing, it must be linked to other middle range theories. One of the approaches used to connect this model with other middle range theories has been in use for the past 20 years or more by nurses who apply concepts of the model. Roy in conjunction with Roberts created a general model of the individual as an adaptive system and may be seen as four middle range theories that are the theory of self concept mode, the theory of physiological mode, the theory of the interdependence mode, and the theory of the role function mode. The theory of the individual as an adaptive system takes into consideration the individual in a holistic manner (Naga & Al-Atiyyat, 2013). The physiological mode theory comprises the regulator subsystem responses that are associated with rest and exercise, elimination, nutrition, electrolytes and fluids, temperature, the endocrine system, the senses, and oxygen and circulation. The theory of the interdependence mode, the theory of the role function mode, and the theory of the self concept mode, on the other hand, sees these modes as systems by which the cognator and regulator subsystems act to facilitate adaptation. Each of these theories explains the essential systems in terms of their subsystems, wholeness, inputs, relation of parts, outputs, control, and self-regulation (Naga & Al-Atiyyat, 2013).

The hypotheses developed from the suppositions of each approach have still not been empirically tested. Roy and Roberts, however, acknowledged the need for a methodical research program to assist in testing the hypotheses that they had developed and others which could be formulated from the approaches (Kaur & Mahal, 2013). In addition, they acknowledged the need for further development and testing of the theory of the individual as an adaptive system. They argued that they should look at the approach of the adaptive individual to additionally describe the interrelatedness of the modes of adaptation. They held that they must look for nonlinear and multivariable relationships during the process. Cognator and regulator processes should be investigated to establish the suggested processes’ hierarchy (Kaur & Mahal, 2013).

The pioneering work of Roy and Roberts paved the way for the origin of other middle range theories in the field of nursing. The cognitive processing nursing model was among the approaches and this is essential in the processing of information. It focuses on the primary cognitive processes of attention and arousal, coding, memory, perception and sensation, language, concept formation, motor responses, and planning (Shyu, 2000). The theory suggests that the most essential cognitive processes that occur in the consciousness fields depend on neurochemical and neurological functions. In addition, it suggests the cognitive processes are focused on coping with focal stimulus of the direct and instant sensory experience while taking into consideration the residual and contextual stimuli of the education and experience of the individual (Shyu, 2000).

Roy has expanded the theory of the role function mode, the theory of the interdependence mode, and the theory of the role function by developing middle range approaches of processes. The theorist suggested that in the adaptation self-concept mode, approaches on personal self and physical self address the development of self processes; approaches on self consistency focus on processes concerned with self and approaches on self ideal focus on the choice of self processes (Roy, Whetsell, & Frederickson, 2009). On the other hand, approaches on moral-ethical-spiritual deal with the valuing of self processes. In the approach of the role function mode, models on primary, secondary, and tertiary functions are focused on the development of roles processes. Theories on role transition are concerned with role taking processes while those on role set tackle the integration of role processes (Roy, Whetsell, & Frederickson, 2009). In the interdependence mode, models on the significant others are concerned with the giving and receiving processes and maturing and learning of relationships processes. Theories on support systems focus on the securing of resources processes.
Callista Roy is a writer, nurse theorist, researcher, teacher, and a researcher. He serves as a nurse theorist and professor in Chestnut Hill, at the Boston College of Nursing. Roy was born on 14th October, 1939 in Los Angeles. He acquired a Bachelor’s Degree in Arts with and majored in nursing in 1963 at Mount St. Mary’s College in Los Angeles (Desanto-Madeya & Fawcett, 2009). In 1966, he attained a Master’s Degree program at the University of California located in Los Angeles where he had specialized in pediatric nursing. He also acquired a Master’s and PhD in Sociology in years 1973 and 1977 respectively. In 1966, Roy worked at a faculty of Mount St. Mary’s College. Roy structured a course content basing on individual and family as systems of adaptation. In 1970, Roy introduced his model in Mount St. Mary’s school, whereas in 1971, Roy was made the chairlady of the college’s nursing department (Desanto-Madeya & Fawcett, 2009).

Explicit Assumptions of Roy’s theory

Roy supposes that the individual is a bio-psycho-social organism. According to this theory, the individual is in consistent interaction or relation with changing surroundings (Desanto-Madeya & Fawcett, 2009). In order to cope with the changing environment and world, an individual uses the innate and acquired techniques or mechanisms that are biological, social, and psychological in origin. Illness and health are unavoidable dimensions of the life of an individual. In order to react positively to these changes in the environment, the individual must adapt according to this theory. The adaptation of an individual is as a result of bathe stimulus that the individual is exposed to, as well as, the level of adaptation (Desanto-Madeya & Fawcett, 2009). The adaptation level of the person is such that it includes a zone showing the degree of stimulation that will result in a positive reaction or response. The theory supposes that the individual has four adaptation modes: self-concept, inter-dependence, physiological needs, and role function. The nursing discipline acknowledges the humanistic perspective of valuing other individual’s thoughts, view points, and opinions. Interpersonal relationships, therefore, are an essential component in the field of nursing. According to this theory, there is a goal for existence with the eventual objective of attaining integrity and dignity.

Implicit assumptions

According to this theory, an individual can be reduced to components or parts for care and study. In addition, nursing is grounded on causality and the opinions and values of the patient should be respected and taken into consideration. A condition of adaptations gives frees one’s energy to react or respond to stimuli (Cypress, 2011).

Major Concepts

An important concept in the theory is adaptation, which is the goal of nursing. The individual is the adaptive system while the environment represents stimuli. On the other hand, health is the adaptation’s outcome while nursing is meant to promote health and adaptation (Cypress, 2011).


On adaptation, the theory explains that it is responding to environmental changes in a positive manner. In other words, it is the outcome and process of people and groups that apply conscious awareness, choice, and self reflection to create environmental and human integration (Cypress, 2011).

The person

The individual is a bio-psycho-social organism in consistent integration with an environment that is changing. The person uses the innate and acquired mechanisms in order to adapt to the environment. The person represents an adaptive system explained as a whole consisted of parts, and functions as a unit for some reason (Shyu, 2000). The theory includes people as groups-families or individuals, communities, organizations, and society in general.


These are the internal and external surroundings that confront the individual directly. This means that the environment represents focal stimulus. In addition, it is contextual meaning that all stimuli reflect in the circumstances that result to focus stimulus effect. There is the concept of residual, which is a factor whose impacts in the present condition are not clear (Cypress, 2011). The environment comprises all circumstances, influences, and conditions affecting and surrounding the behavior and development of individuals and groups with certain concern of mutuality of an individual and resources of the other such as contextual, residual, and focal stimuli.


Health is regarded as an unavoidable dimension of an individual’s life. It is represented by a health-disease scale, and it is a process and state of being or becoming whole and integrated.


Nursing, according to this theory, is aimed at promoting the adaptation of the four modes mentioned. It is aimed at promoting adaptation of groups and individuals in the four modes of adaptation, therefore, leading to improved quality of life, or even dying with dignity through assessing factor and behaviors which affect adaptive abilities and through intervention in order to promote environmental interactions (Shyu, 2000).


There are two subsystems represented in Roy’s model. The first is the regulator subsystem, which is an essential form of adaptive process which reacts automatically through chemical, endocrine, and neural coping channels. The other one is the cognator subsystem, and is also an important process of coping that involves four channels of cognition. These are learning, emotion, judgment, and perceptual and information processing. Relationships are important in this theory, and there are a few things that the nurse of care giver needs to ask himself or herself when dealing with the patient (Dobratz, 2004). These include things such as what the patient was doing through assessing samples of his or her behavior and what the person looks like when in need of nursing care. These are all based in the four modes of adaptation of the theory (self-concept, interdependence, role function, and physiological needs).

Theory Development

Philosophical Assumptions

People have mutual relations with the environment (world), as well as, with God. The meaning of human is grounded in the universe omega point of convergence. Another philosophical supposition of the theory is that God is closely shown in the creation diversity, as well as, its universal destiny of creation. People use enlightenment, faith, and creative capacities of deriving (Dobratz, 2004). They are responsible for the sustaining, deriving, and the transformation of the universe processes.

Adaptation and Groups and Adaptive Modes

These relate to individuals, families, partners, communities, organizations, nations, and society at large. The four adaptive modes (physiologic, role function, interdependence, and self-concept) apply to all persons. On groups the adaptive modes are group identity, interdependence, physical, and role function (Cypress, 2011). The role function mode is the underlying need for social integrity, the need for clarity of roles in terms of all group’s participants, and the need to know the individual in terms of other people who can act. The level of adaptation refers to the zone in which simulations will result in an adaptive or positive response. The processes of mode adaptation are explained on three major levels that are integrated, compensatory, and compromised.

Integrated Processes of Life

These processes occur at the level of adaptation where the function and structures of processes of life operate to achieve needs. Some examples of integrated adaptation include stable process of ventilation and breathing. These are effective processes for ethical, spiritual, and moral growth (Dobratz, 2004).

Compensatory Life Processes

These occur at the level of adaptation where the regulator and cognator are activated by a problem to the processes (Dobratz, 2004). Examples include transcendence and grief as a process of growth. Growth is a new role in the concept of role transition.

Compromised Life Processes

Occur at a level of adaptation that is a result of insufficient compensatory and integrated life processes (Dobratz, 2004). They represent a problem in adaptation. Examples include hypoxia, stigma, unresolved loss, and abusive relationships.

Usefulness of the theory and the nursing process

The theory provides guidelines to nurses in the development of the process of nursing. The major elements in the nursing process include the first and second level assessment, diagnosis, setting of goals, intervention, and evaluation (Kaur & Mahal, 2013). The theory is used in clinical assessment and intervention. It is also used for scientific knowledge used for practice in nursing. It guides the practice of nursing and is used in the development of variables of research. It serves as a curricular framework for a number of nursing colleges and is used in the organization of nursing education (Kaur & Mahal, 2013).

Summary and Conclusion

The theory is effective and is widely used by nurses in research and practice. The theory is logical in nature and interrelated. It can be the ground for the hypotheses which can be tested and is simple, although it can also be generalized. The adaptation model is testable and contributes and helps in improving the knowledge of the discipline of nursing. The theory can also be used by the practitioners to improve and guide their practice. It is consistent with other laws, principles, and theories that have been validated.



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Kaur, H., & Mahal, R. (2013). Development of Nursing Assessment Tool: An Application of Roy’s Adaptation Theory. International Journal of Nursing Education, 5(1), 60.

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Shyu, Y. L. (2000). Role Tuning between Caregiver and Care Receiver during Discharge Transition: An Illustration of Role Function Mode in Roy’s Adaptation Theory. Nursing Science Quarterly, 13(4), 323-331.



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