They further assert that central to understanding
how well a person can cope with any stressful con-
dition in aging is understanding how one main-
tains consistency of self and whether one is able to
achieve that goal.
Instrument Development
Based on extensive literature review on theories of
self-concept and self-consistency (Andrews, 1990;
Beck, 1976; Elliot, 1986; Goffman, 1959; Lecky,
1961; Mead, 1934; Rogers, 1961; Rosenberg, 1979;
Roy & Andrews, 1991; Wylie, 1989), Zhan devel-
oped the Self-Consistency Scale (SCS). A measure
of self-consistency is based on the assumption that
an individual has the capacity for self-examination
and evaluation. Therefore, self-perception and self-
evaluation are consciously available and can be
reported by the individual. Twenty-seven items
in the SCS reflect the concepts of self-esteem, pri-
vate consciousness, social anxiety, and stability of
self-concept.
Self-esteem was measured by a global index con-
taining six items that were originally developed by
Rosenberg (1979, 1989). Elliot (1986, 1988), in ex-
amining the relationship between self-esteem and
self-consistency among a sample of 2,625 young
people (ages 8 to 19), found that self-esteem was
highly correlated with self-consistency. An example
item reflecting the concept of self-esteem in the
SCS was: “I feel that I am a person of worth, at least
on an equal with others.” Private self-consciousness
measures how preoccupied the individual is with
his or her personal characteristics or the individ-
ual’s tendency to be the focus of his or her own at-
tention. Being excessively focused on one’s own
characteristics is likely to lead to negative affect,
as the individual becomes increasingly aware that
he or she does not meet those “standards of cor-
rectness” set for the self (Elliot, 1986). Therefore,
excessive private consciousness leads to less self-
consistency. A sample item in the SCS was: “I spend
a lot of time thinking about what I am like.”
Stability of self-concept refers to the sameness
of self-concept across time and space (Elliot, 1988).
It measures the continuity of self-concept. A sam-
ple item in the SCS was: “I feel I know just who
I am.” Social anxiety is viewed as one’s reaction to
social stimuli. It measures one’s worry about
others’ appraisals in social settings. High social
anxiety leads to less self-consistency (Elliot, 1986).
A sample item in the SCS was: “I think about how
others are looking at me when I am talking to
someone.” Private self-consciousness and social
anxiety could be viewed as mediating factors in
self-consistency.
Each item of the SCS was scored on an ordinal
scale from 1 to 4, with 1 indicating “never” and 4
indicating “always.” Positive and negative items
were ordered in a way to reduce the responsive set.
For analysis, all negative items were reverse scored,
so that a higher score would indicate a greater self-
consistency. An example of a reverse-scored item
was: “I feel mixed up about what I am really like.”
The SCS was administered to a sample of 130 older
people. Psychometric evaluations of the SCS re-
vealed an internal consistency reliability of .89, with
a score range from 51 to 104, a mean total score of
85.10 and standard deviations of 11.04 (Zhan &
Shen, 1994). Content validity was supported by ex-
tensive and concurrent literature research in the
field of self-consistency and self-theory and by an
expert panel consisting of four university faculty
members who validated each item in the SCS.
Convergent validity was supported by a signifi-
cantly positive correlation between a Visual Analog
Scale, “A Sense of Self,” and the SCS,r .60,p
.01. Divergent validity was supported by a signifi-
cantly negative correlation between the SCS and
the Geriatric Depression Scale (GDS),r 2.57,p
.01. Using the GDS was based on the theoretical
proposition that a lack of self-consistency leads to
certain affective disorders, including depression
(Beck, 1976; Lecky, 1961; Rosenberg, 1979, 1989).
Therefore, the effects of its absence can perhaps
best assess the strength of self-consistency.APPLICATION OF THE MODEL
USING A RESEARCH EXEMPLAR
TO STUDY ELDERLY PATIENTS
WITH HEARING IMPAIRMENT
It has been noted that the Roy Adaptation Model is
useful in all areas of nursing practice and has been
the basis of research questions to develop basic and
clinical nursing science for people of all ages in
health and illness (Roy & Andrews, 1999). Several
authors have noted the model’s particular relevance
to assessment and intervention during the changes
that occur across the life span. Particular changes
within human development are the physical
changes experienced in aging. Thus, research with
elderly adults who are adapting to physical changesCHAPTER 17 Sister Callista Roy’s Adaptation Model and Its Applications 275