Abstract Two key events lead to the prominence of links among Roy’s grand theory, derived

Abstract Two key events lead to the prominence of links among Roy’s grand theory, derived middle-range theories and the design of research. The author in this column describes this work in two formats. Essential details of two areas of research are presented in episodic form—the first is work on secondary analysis of Roy model-based research over 40 years and the author’s study of persons’ cognitive recovery from mild head injury. The second is a project on re-conceptualizing coping and adaptation processing in sequential detail within the context of work in the field and the significance of on-going work for nursing practice. The story of research based on the Roy adaptation model (RAM) can be told in many ways. When asked to write about research based on the RAM in the past 25 years I considered the major events of those years and also how to organize a description of the resulting research. First, I considered that it was 20 years ago that the first group presented a synthesis and critique of studies based on the RAM by five different investigators (Pollock et al., 1991). This was the beginning of the Roy Adaptation Association (RAA) currently with five international chapters. It was the beginning of an on-going project to analyze, critique, and synthesize all published studies in English based on the RAM. Secondly, doing 4 years of full-time clinical research in neuroscience nursing, beginning with post doctoral work as a Robert Wood Johnson Clinical Nurse Scholar in 1983 at the University of California at San Francisco, provided the opportunity to focus my research on the cognator as a major element of the RAM. In this column I present an overview of the major RAM-based research derived from these key events. Two different styles were selected to present the significant research of this timeframe.Synopsis of 25 Years of Roy Model-Based ResearchThe overall view of RAM-based research in Figure 1 depicts how major theoretical concepts (in rectangles) from a grand theory, guide middle-range theory development (in ovals) from which research projects (in squares) are designed. The theory of the cognator initially was described as part of the theory of the person as an adaptive system (Roy & McLeod, 1981). In explicating the cognator subsystem I had identified pathways for perceptual/information processing, learning, judgment, and emotion. This work was significantly refined by post doctoral studies in neuroscience nursing (Roy, 1988, 2001). The middle-range theory of cognitive processing (Figure 2) was developed to show the major processes involved in the input, central, and output phases of cognitive processing. These processes were embedded in another major concept of the model, the environment. The environment includes focal stimuli as immediate sensory experience and contextual and residual stimuli involving education and experience. Figure 1. Roy adaptation model research synthesis. Note. RAA = Roy Adaptation Association, BBARNS = Boston-Based Adaptation Research in Nursing Society Open in viewerFigure 2. Middle-range theory of cognitive processing.Open in viewerEarly work on the RAM (Roy, 1976) also identified the major theoretical concept of coping in four adaptive modes. These modes represent the categories whereby the nurse assesses behaviors that persons use to deal with their internal and external environments. The behaviors are viewed as stemming from the central processes of persons, the cognator and regulator. The modes were named from a content analysis of 500 samples of patient behavior collected by student nurses. The categories physiologic, self concept, role function, and interdependence have remained useful through the years for education, practice, and research (Roy, 2009). The theory of coping in the adaptive modes was combined with the middle-range theory of cognitive processing and empirical work, as described below, resulting in a middle-range theory of coping and adaptation processing.This theoretical work was used to derive the major research projects reported here and named in Figure 1 within the squares. To handle the challenge of presenting this array of work in one column I turned to an image of two kinds of clocks (Carroll, 2011). The analogue clock has a numerically defined face and pointed hands that mark seconds, minutes, and hours by an endless succession of circles in motion with a context and a dynamic sequence. The digital clock, however generally shows only hours and minutes with the numbers remaining static until a shift occurs. The kind of time on this clock is episodic rather than continuous. Based on this image of time, I decided to present an episodic digital picture of two major research projects. Firstly, a secondary analysis research project used the 360 studies in an integrated review of Roy model-based research to test propositions derived directly from the major theoretical concepts of the model. The rationale for this approach to this project is that it is the work of teams, the executive board of the RAA, all the investigators who published their research, and the student research fellows who have assisted us. Still, it provides clear and rich information on research based on the model from 1970 to the present and how the review has been used to develop knowledge for nursing. Secondly, one of the major foci of the middle-range theory of cognitive processing involved the design and testing of interventions for cognitive recovery of people with mild head injuries (Roy, 2010, 2011). This work calls for the essentials episodic approach because it is a recently completed comparative intervention study that was presented nationally as a paper (Roy, 2010) and locally (Roy, 2011) with two publications in preparation.Another major focus of my research over these years lends itself to a presentation more like the analogue clock, that is, the dynamic process and context of the sequential stages. This involved a re-conceptualization of coping to develop a measurement tool based on the concept of coping and adaptation processing and to derive additional research projects.Coping and Adaptation Processing Theory and Research Development in General LiteratureCoping is recognized as the crucial variable in understanding the effect of stress on physical and mental health (Aldwin, 2007). Based on the significant function of coping, healthcare clinicians often aim to promote coping abilities of patients and their families. Yet in spite of significant theoretical and research literature in many fields, knowledge effective in practice has remained elusive. Two approaches identified as showing the greatest promise were multidimensional (Frydenberg, 2002) and transactional processes (Aldwin, 2007). The Roy adaptive modes and an in-depth understanding of cognator processing, representing both cognition and emotion, provided a basis for studying coping as a multidimensional and transactional process to add to knowledge for nursing practice. The revised conceptualization of coping, derived theory development, and inductive and deductive empirical strategies were the basis for developing, a middle-range theory, a new instrument, and intervention.Background: General Literature on CopingEarly work on coping tended to look at psychopathology. Further cognitive and physiologic concepts and variables were used with little attention given to emotion. Through the decades of the 1980s and 1990s scholars continued to refine conceptualizations and measurement of stress and coping. In the 1990s there was a shift toward positive psychology and the positive role of emotions, crystallized by Seligman as president of the American Psychological Association (Snyder, 1999). Lazarus is credited with the shift from coping, viewed as a response to emotion, to coping and emotion understood in a dynamic relationship (Lazarus, 1991,1999). In the 1990s, issues in the field were identified as measurement styles versus processes (Aldwin, 1994); trying not entirely successfully to examine both the person and environment (Schwarzer & Schwarzer, 1996); the need to balance deductive and inductive approaches to provide a theoretical base for scale items, and to have a closer match between concept and measurement (Schwarzer & Schwarzer, 1996).In 2007 Aldwin updated an earlier review to handle the burgeoning general literature that added 186,000 articles on stress and 37,000 articles on coping in the intervening years. Aldwin addressed the on-going issues of conceptualizations and measurements. She divided the theoretical approaches that are person-based into three schools, that is, psychoanalytic, personality trait, and perceptual styles. Those who focused on situational determinants of coping noted that the types of strategies that individuals use in coping with problems depend on environmental demands, or the pull for different types of solutions. Aldwin further noted that cognitive approaches assumed: that individual coping is largely dependent upon appraisal of the situation; that individuals are flexible and coping strategies have some degree of situational specificity; that both problem-solving and emotion-focused strategies are used in coping efforts; and, that there is not necessarily a hierarchy of adaptation. The author’s analysis showed that a majority of coping researchers have adopted at least some aspects of the cognitive approach. However, many continued to regard the use of coping strategies primarily as a function of personality. Aldwin (2007) concluded that the extent to which coping strategies are a function of both the person and the environment is a matter of some debate and that “coping affects adaptation in extremely complicated ways” (p. 126). The issue of state versus trait was not yet settled.In dealing with measurement, Aldwin (2007) stated that this is still the most controversial issue in the field. Laboratory, paper and pencil tests, and qualitative research are all used. The person versus environment conceptualizations may be at odds or creative strategies are used to combine both. One way that researchers have addressed this problem is to develop coping scales that are specialized by situations or the strategies measured. Aldwin reported that in 1987 she identified over 20 coping scales; in 1994 the list was updated to 70; and in 2007 there were 200 references to coping scales. She identified increases in scales in languages other than English, those for children and adolescents, and those with highly specialized strategies. In a list of coping scales for clinical health situations, Aldwin included, for example, coping with asthma in everyday life. What level of evidence is this article?

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