self-enhancing evaluation. Taylor’s propositions are
in concert with Roy’s assumptions of cognitive
adaptation, in which individuals make cognitive
efforts to understand the purpose of their lives,
maintain their sense of self, and enhance their
well-being.
Instrument Development
In developing a new instrument, Roy sought to
address issues in the measurement of coping as
identified by Aldwin (1994) and Schwarzer &
Schwarzer (1996). Further, it was important to have
a tool that is useful for nursing assessment and in-
tervention. Based on the cognator subsystem of the
grand theory, Roy developed a middle-range theory
of Coping and Adaptation Processing (Roy &
Chayaput, 2004; Roy, in review). The theory identi-
fies how adaptation is manifested in the four adap-
tive modes, which provides for multidimensionality
and is accomplished by the three stages of informa-
tion processing that are hierarchical, from input to
central to output processes. Items of coping strate-
gies within these categories were generated by pa-
tient interviews and nursing care plans based on the
Roy model, as well as by deductively derived cate-
gories of information processing, with related pa-
tient observations to identify related strategies. A
total of 73 items were developed using these ap-
proaches. For the tool, 47 items met all criteria
for inclusion and represented all dimensions and
processes of the constructs of the middle-range
theory.
The psychometric properties were established
with a data set that included 349 subjects from non-
probability purposive samples from national mail-
ing lists of patient support groups for persons with
long-term neurologic deficits. The Thai translation
of the CAPS was conducted, and the psychometric
properties were established by Roy & Chayaput
(2004) with a sample of 580 medical and surgical
Thai patients with acute illnesses from three hospi-
tals in Thailand. The five factors of the CAPS were
extracted in five iterations. Factor 1,resourceful and
focused,contained 10 items with factor loadings
ranging from .71 to .49 and explained 26.6 percent
of the variance. Factor 2,physical and fixed,had 14
items with factor loadings from .72 to .43 and ex-
plained 8.4 percent of the variance. Factor 3,alert
processing,had nine items with loadings from .61 to
.49 and explained 3.8 percent of the variance. Factor
4,systematic processing,contained six items with
loadings from .71 to .31 and explained 3.3 percent
of the variance. Finally, Factor 5,knowing and relat-
ing,had eight items whose loadings ranged from .63
to .31 and explained 3.2 percent of the variance.
The Thai version was considered comparable to a
large extent.
A 48-item CAPS for the elderly had been se-
lected from the longer set of items. This version of
the scale was used in the research exemplar de-
scribed in this chapter. The items retained were in-
clusive of the inferred coping strategies, and the
categories were derived from the nursing model for
cognitive processing. Content-validity of the CAPS
was based on both the strong theoretical-empirical
basis for its development and the review by content
experts. Internal consistency reliability for the total
scale was .85 (Zhan, 1993a). The conceptual clarifi-
cation of this version of the CAPS was further ex-
amined by using a principal component factor
extraction with a varimax rotation, resulting in five
factors that accounted for 48 percent of variances
among the scores (Zhan, 1993b). At that time, Roy
termed these five factors (1) cognitive processing of
self-perception, (2) clear focus and method, (3)
knowing awareness, (4) sensory regulation, and (5)
selective focus. The scores on this version of the
CAPS can range from 48 to 192; a total high score
represents a greater use of cognitive adaptation
strategies.
Cognitive processing of self-perception refers to
self-awareness, self-analysis, emotion, and con-
sciousness (Carver & Scheier, 1991). It serves to sig-
nal needs for cognitive efforts, to help the person to
attend, and to interfere with cognition. Examples of
items were “keep in touch with emotions,” “put
things into perspective,” “rechannel feelings,” and
“be aware of self-limits.” Cognitive processing of
clear focus and method refers to programming, at-
tention, thinking, reasoning, problem solving, con-
cept formation, and cognitive coding. It involves
systematic thinking. The real process of systematic
thinking lacks full understanding. However, it can
be viewed in part as a process in which people clas-
sify the problem, organize information to accom-
plish some desired end, and weigh the benefits and
risks of their efforts to their self-structure (Das,
1984; Luria, 1980; Roy, 1988b, 2001). The thinking
process requires knowledge of the adaptation en-
counter, perceptions of one’s thoughts, action ten-
dencies, and bodily changes. Items included: “give
self time to grasp situations,” “be objective aboutCHAPTER 17 Sister Callista Roy’s Adaptation Model and Its Applications 273