The purpose of this assignment is to describe, evaluate and discuss application of a nursing
grand or mid-range theory. This assignment also provides the learner an opportunity to
connect theory and research to nursing phenomena. Learners will develop an 8-10 page
paper (excluding the title page and references) using APA style to address the elements
listed below.
Theory/Author Name and Background
Select a Grand or Mid-Range Theory that is appropriate to your practice setting.
Describe the theorist’s background in detail and discuss how their experiences have
impacted the theory development.
Examine crucial references for the original and/or current work of the theorist and other
authors writing about the selected theory.
Identify the phenomenon of concern or problems addressed by the theory.
Theory Description
Explain whether the theory uses deductive, inductive or retroductive reasoning. Provide
evidence to support your conclusion.
Describe the major concepts of the theory.- How are they defined? (theoretically and/or
operationally) Is the author consistent in the use of the concepts and other terms in the
theory?
Interpret how the concepts are defined.- Implicitly or explicitly?
Examine the relationships (propositions) among the major concepts.
Evaluation
Identify explicit and implicit assumptions (values/beliefs) underlying the theory. On what
assumptions does the theory build?
Examine if the theory has a description of the four metaparadigm concepts of nursing. If
so, how are they explained in the theory? If the metapardigm is not explained, what
elements do you see as relevant to the theory and why?
Discuss the clarity of the theory.- Did it have lucidness and consistency?
Application
Examine how the theory would guide nursing actions.
Describe specifically how you can use this theory in your area of nursing (Practice,
Education, Informatics or Administration).
NURSING THEORY ANALYSIS PAPER 2
Nursing Theory Analysis Paper
Introduction
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
NURSING THEORY ANALYSIS PAPER 3
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 21 st 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
NURSING THEORY ANALYSIS PAPER 4
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
NURSING THEORY ANALYSIS PAPER 5
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.
NURSING THEORY ANALYSIS PAPER 6
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 14 th 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
NURSING THEORY ANALYSIS PAPER 7
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).
Adaptation
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
NURSING THEORY ANALYSIS PAPER 8
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.
Environment
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
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
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).
Subsystems
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
NURSING THEORY ANALYSIS PAPER 9
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
NURSING THEORY ANALYSIS PAPER 10
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
NURSING THEORY ANALYSIS PAPER 11
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.
NURSING THEORY ANALYSIS PAPER 12
References
Cypress, B. (2011). Patient-family-nurse intensive care unit experience: A Roy adaptation
model-based qualitative study. Qualitative Research Journal, 11(2), 3-16.
Desanto-Madeya, S., & Fawcett, J. (2009). Toward Understanding and Measuring Adaptation
Level in the Context of the Roy Adaptation Model. Nursing Science Quarterly, 22(4),
355-359.
Dobratz, M. C. (2004). A Dialogue about Two Nursing Science Traditions: The Roy Adaptation
Model and the Human Becoming Theory. Nursing Science Quarterly, 17(4), 301-307.
Elcock, K. (2010). What is Nursing? Exploring Theory and PracticeWhat is Nursing? Exploring
Theory and Practice. Nursing Standard, 24(25), 30-30.
Jim, E. (2014). Situation-Specific Theories from the Middle-Range Transitions Theory.
Advances In Nursing Science , 37(1), 19-31.
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.
Naga, B. S., & Al-Atiyyat, N. M. (2013). Roy Adaptation Model. Middle East Journal of
Nursing, 7(1), 35-38.
Roy, C., Whetsell, M. V., & Frederickson, K. (2009). The Roy Adaptation Model and Research:
Global Perspective. Nursing Science Quarterly, 22(3), 209-211.
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.