Changes in theory and direction related to patient care were dynamically evolving. Theorists worked to define nursing in a distinct way that separated medical and nursing frameworks. This period presented new ideas, “this change offered the opportunity to move nursing from a context-dependent reactive position to a context-interactive proactive position” (Chinn and Kramer, 2011, p. 44-45 ). Roy's coping model states that “nurses direct their care to help the client cope” (Potter & Perry, 2009, p. 50). Additionally, the nurse must interact with each patient to assess their own feelings regarding their current health status, environment, and goals in order to anticipate interventions that may be needed to encourage coping. Callista Roy worked for more than three decades to further detail her model. Over the years, modifications have been made to the initial model. Earlier versions of the RAM included three “…essential elements: the person, the goal, and the nursing intervention” (Roy & Roberts, 1981, p. 42). However, a more recent publication includes five concepts in the definition of the model: adaptation, person, environment, health, and purpose of nursing (Roy, 2009). It also defines four adaptive modes that describe how a person responds to environmental stimulation (Roy,