Callista Roy’s adaptation model explains that peoples’ environments are constantly changing. Adaptation occurs when an individual can respond positively to the environmental changes. This model includes a person as an individual, as well as in a group, for example, a family or organization (Smith, 2020).
The difference in the adaptive model between the individual and the group is for the individual “the mode focuses on interactions related to the giving and receiving of love, respect, and value” (Smith, 2020, p.153). Roy explained that the underlying need of this model was to feel secure in a nurtured relationship. For those within a group, this mode “relates to basic operating resources- participant, physical facilities, and fiscal resources” (Smith, 2020, p.153). The mode “comprises interpersonal relationships, group self-image, social milieu, and culture” (Smith, 2020, p.153). According to Roy, in a hospital setting an example of this would be a social environment in which nursing staff, administrators, and other staff feel they can count on one another, and share similar values (Smith, 2020). 
From Roy’s point of view, the environment consisted of three components referred to as stimuli’s’. Nurses aim to manage focal stimuli first, then contextual and residual (Ursava?, et. Al, 2014). Focal stimuli are combination of internal and external factors directly confronting the individual, requiring the most attention. An example of this would be an asthmatic patient experiencing shortness of breath in that current moment. As provided by our text (Smith, 2020, p.159), another example of focal stimuli would be profound emotion being experience after experiencing loss of a loved one. 
Contextual are stimuli that directly contribute to the focal stimulus, and therefore affect the current situation (Smith, 2020). In my example of the asthmatic patient, contextual stimulus may be the presence of a nurse providing care, and medications to alleviate symptoms. Following the example from the text, when a person experiences profound emotion secondary to loss, contextual stimuli would be the availability of social and emotional support. The presence of support would have a great impact on the emotional being of the individual in that moment. 
Lastly, residual stimuli are factors that do have affect the current situation, but their effect is unclear. For example, this may be a patients’ beliefs and prior experiences. The asthmatic patient for instance may have had a prior asthma attack which led to status asthmaticus, requiring intubation. This individuals’ prior experience could result in increased anxiety related to the persons’ current state. An example of patient’s belief being a residual factor, for the individual experiencing profound emotional loss, potentially their belief in where or not their love one suffered, may hinder their ability to find peace.
Open ended questions are important part of patient assessment. These questions can help generate deeper conversation with your patient. They offer a much thorough look into your patient’s life and allow you to better understand their true feelings and perspective. As an advanced practice nurse, some examples question’s we can ask patients to elicit information regarding their feelings, environment and support system could be:
1. What are you concerns? Explain to me how you are feeling right now. 
2. What do you hope to return to doing when you leave the hospital?
3. Do you have a support system at home? Do you feel that they help or hinder your health?
4. What are the biggest obstacles you feel that you face in your home environment?
Roy’s model defined three levels of adaption; integrated, compensatory and compromised levels of adaptation. Roy defined integrated adaptation as “structures and functions of the adaptive models successfully working as a whole to meet human needs” (Smith, 2020, p.154). In the example of someone experiencing a profound loss, integrated adaption would be having efficient coping methods, and sufficient support systems. Compensatory adaptation is when defense mechanisms have been activated because of a challenge to the integrated life process (Jennings K. M., 2017). The individual will attempt to reestablish an integrated adaptation level. If a person is unable to achieve integrated adaptation again, this results in a compromised level of adaptation. For example, if a person experiencing profound emotion from loss does not cope properly and is without a sufficient support system, they may enter a state of depression. Being in a state of depression would pose as an example of a compromised level adaptation; the result of inability to reestablish an integrated adaptation level. 
Callista Roy viewed the person as both an individual and group, in a continuous interaction with a constantly changing environment. In summary, integrated adaptation is the ideal level to be, and when a challenge is faced, lack of ability to compensate, results in compromised adaptation. This model can be applied in every day nursing while caring for patients with unpredictable circumstances. Roy’s model reminds nurses when treating patients to consider the whole individual, and their surrounding environment