GROUP A
PRESENTS
One draw of the field of nursing is the ability for nurses to individualize their care plans for their patients. In order to ensure that unique patients are able to get healthy, they need nursing care plans as unique as they are. This means assessment and evaluation of each patient before and during care. Nancy Roper's desire to become a nurse started in childhood, and as a result of her experiences and education, she, along with two of her colleagues, developed the Roper-Logan-Tierney Model of Nursing to assess patients' level of independence and provide the best individualized care for them.
COMPONENTS/CONCEPTS OF THE MODEL
Living
is a complex process which we undertake using a number of activities that
ensure our survival. The current model seeks to define 'what living means, and
categorizes these discoveries into Activities of Daily Living (ADL). According to Roper, in a given circumstance,
people are able to perform daily activities of living independently but when disease
or hindrances occur, the nurse can use these activities of living to be able to
assess the patient and identify interventions that can support independence in
areas that may prove difficult or impossible for the individual on their own.
The model assesses the individual's relative independence and potential for
independence in ADLs,(considering their lifespan, development, and the five key
factors on a continuum ranging from complete dependence to complete
independence) in order to determine what interventions will lead to increased
independence as well as what ongoing support is or will be required to
compensate for dependency.
These
activities, including the activities that each patient routinely do as well as
the changes that occur from any health condition, are assessed upon admission,
and are reviewed as the patient progresses and as the care plan evolves. To
provide effective care, all of the patient's needs must be met as practicably
as possible through supporting the patient in meeting those needs independently
or by providing the care directly, most preferably by a combination of the two.
1. Maintaining a safe environment- In order
to stay alive and carry out any of the other AL, it is imperative that actions
are taken to maintain a safe environment (Roper et al 1996,p21 ) These actions
may include activities such as prevention of accidents in the home, driving
carefully or washing hands after elimination. Roper and the other authors of
the model believed that as the environment affects us, human being also affects
the environment giving us the responsibility of taking good care of it for our
own sake.
2. Communication- Roper st al
(1996) Human beings are essentially social beings and a major part of living
involvescommunicating with other people in one way or another. Communicating
not only involves the use of verbal language as in talking and writing, but
also the non-verbal transmission of information by facial expression and body
gesture.
3. Breathing- is an activity that is
essentialfor life itself and all other activities are therefore dependent on us
being able to breathe. Breathing ensures that oxygen is taken into the body and
carbon dioxide is removed. This process helps maintain the body's homeostasis.
4. Eating and drinking-It is
essential to maintain the body's homeostasis, and we need to eat the right food
and drink the right fluids that ensure the correct balance. Eating and drinking
are dependent on being able to afford to buy food and drink.
5. Elimination- eliminating is a private
activity. It also helps in maintaining the body's homeostasis making sure that
toxins from the body are removed.
6. Washing and dressing- Ropert et al
(1996) -Chose to call this activity personal cleansing rather than washing, and
have included the activities of perineal hygiene, care of hair, nails, teeth
and mouth as well as hand-washing and bathing.
7. Controlling temperature- our human
body are programmed to control temperature of our body for proper functioning.
extremes in temperature can disrupt our body's function.
8. Mobilization-Roper et al (1996) The
movement produced by groups of large muscles, enabling people to stand , sit,
walk and run as well as groups of smaller muscles producing movements such as
those involved in manual dexterity or in facial expressions, hand
gesticulations and mannerisms, all of which are part of non-verbal
communication.
9. Working and playing- Working for
most people offers a way of obtaining income to support how they live.
10.Expressing sexuality- Encompasses
more than sex and sexual activity. It relates also to how we see ourselves and
our bodies in relation to each other and how we behave in society.
11. Sleeping-Sleep enables the body to
relax from the stresses of everyday living and it is also during that growth
and repair of cells tkaes place( Roper et al 1996,p.22 )
12. Death and Dying- death is
inevitable but we can help patient's experience this process in the most
comfortable way possible
Biological – is the over-all
health status of the patient considering his anatomy and its function. On this
aspect we consider the illness of the patient, injuries or disabilities and the
ways on how his body adapts. For an example, a patient with anemia may be
easily fatigued hindering the person to do his activities of living
independently. On the other hand, a person who has an amputated leg using a
wheelchair can still do his activities of living independently with proper
adaptation. Health status has a big impact in the capacity of patients to
independently perform their activities of living. Present illness can disturb
plenty of the normal functions of the patient that it can abruptly disrupt the
competence of patients to perform activities of living.
Psychological - According to Roper,
this is about knowing, thinking, hoping, feeling and believing. This aspect
includes the person’s emotions, ability to comprehend and grasp ideas,
spiritual/ religious belief and cognition.
Sociocultural – is the effect of
the society and culture in the expectations given on individual in attaining
his needs indepedently. This may be affected by societal status,
responsibilities and position in the society, and beliefs. For an example, 15
years old in the Philippines may sometimes be viewed as someone who is too
young to take on responsibilities thus limiting his responsibilities and work
that he could have achieved independently given the chance of doing it alone.
Environmental – pertains to the
effect of the society in the ability of a person to perform his activities of
living independently
Politicoeconomic – is the aspect where
the government and the status of the economics affect the ability of a person
to attain his needs. For an example, in
the time of the Martial Law, the actions of people have become limited that
they are no longer able to do the mentioned 12 activities of living. They have
the capacity for independence but they were set with limitations that they were
not able to do such activities.
The model also
incorporates a life span continuum, where the individual passes from fully
dependent at birth, to fully independent in the midlife, and returns to fully
dependent in their old age/after death. Some researchers argue that the life
span continuum begins at conception, others that it begins at birth
Roper et al (1996)
said that as a person moves along the lifespan there is a continous change and
every aspect of living is influenced by the biological, psychological,
socio-cultural, environmental and politico-economic circumstances encountered
throughout life.
5 stages of Life
1.Infancy
2.Childhood
This component of the
model is closely related to the lifespan and to the ALs. It is included to the
acknowledgement that there are stages of the lifespan when a person cannot yet
perform certain ALs independently. By
considering changes in the dependence-independence continuum, one can see how
the patient is either improving or failing to improve, providing evidence
either for or against the current care plan and giving guidance as to the level
of care the patient does or may require. This value only results when the
assessment is done frequently as changes occur and if it is combined with
health improvement and health promotion.
Each individual will
experience and carryout the ALs differently. Each one of us will act
differently or adapt in the most unique way in every life stages. Furthermore,
the dependence/independence continuum maybe further fashioned by the influence
of various biological, psychological, socio-cultural, environmental and
politico-economic factors and the effect of these maybe different from each
person who experiences it. It is the responsibility of the nurse to identify how each patient reacts to all of the influences of the activities of living to be able to create a plan that is patient oriented.
Individualizing Nursing Care and the Nursing Process in the Roper-Logan-Tierney Model
l
Each patient is unique in the
nurse-patient relationship. The ROPER et al (1996) model for nursing offers a
framework for nurses to be able to ensure that this individuality is taken into
account when undertaking nursing care. It is one framework used to guide nurses
in the delivery of patient care and the design of the care plan documentation.
In order to ensure that all aspects of an individual's life are integrated into
an effective plan of care, Roper et al (1996) use a problem-solving approach
and the nursing process in conjunction with their model for nursing.
Roper viewed The NURSING PROCESS as a
systematic approach to planning and delivering nursing care and followed Yura
and Walsh's (1978) identified 4 main stages of the process:
•Assessment
•Planning
•Implementation
•Evaluation
The video(s) being shown
here is treated with strict confidentiality and with permission from the
participants who were involved in the interview.
The interview was
conducted in two (2) different NHS hospitals in United Kingdom. Participants
composed of one (1) student nurse and two (2) professional nurses from
different fields of practice namely: Day Surgery Unit (DSU) and Post anesthetic
Care Unit (PACU). The interviewer is Ms. Lotus Aquino, a recovery nurse
practitioner from London NHS hospital.
The participants have
voluntarily agreed to introduce their line of work, the kind of assessment
tools they use in their respective areas and briefly discuss on how they
utilize these tools in their daily professional practices.
OBJECTIVES OF THE
INTERVIEW
To identify the
flexibility of Roper, Logan andTierney Theory.
To determine the
assessment tools they adopt in their workplace.
To evaluate the effectiveness
of Roper, Logan and Tierney Theory in practice.
Based on the interview, nurses testified and concluded that the use of Roper, Logan and Tierney Theory is a good theory in such a way that it is:
>less time consuming, contrary to other
sources who quoted that it is time consuming.
>more convenient to use on the part of
the nurses
>less stressful on the part of the
patients
>the theory is flexible, no matter what
field a certain nurse is.Whether be in NICU to ITU, from >infancy to geriatrics,
such theory can be use.
>easy to draw nursing care plan as
problems can be identified straight from admission through proper assessment.
In a study conducted
by O’ Connor (2002), The processing of Baby David’s care using the Roper, Logan
and Tierney model provides an invaluable contribution to nursing.
This contribution may be considered under the following headings:
ü Accessibility of
theory - The model is easy to use and easy to translate into practice. This
gives the practitioner a sense of ‘ease’ with nursing theory as opposed to
scepticism or rejection, which is common where concepts appear difficult to
understand.
ü The continuum scale -
It can be easily incorporated into the assessment and care planning of infants
and clearly identifies to the nurse that the infant’s dependency is due to his
or her position within the lifespan, in addition to the current condition that
exists.
ü B. Newton (1992)
said, that the model prevents the nurse from focusing on “the presenting
problems” but allow the patient to be assessed as a whole, incorporating all 12
activities of living that is influence by the five factors.
ü C. Marks-Maran and
Rose (1997) report that some authors believe that the physical assessment
predominates over the psychological in the model. However, it could be argued
that this is a reflection on those using the model rather than the model
itself.
By: Meldalida Aghaali
Assessment is the key to good nursing care and interventions. Being assigned to different age group and different cases taught me to be sensitive in taking assessment from pediatric cases, to medical cases and surgical cases. I am not yet proficient in my field because I only started last year and there are times when I forget to assess one area or forget to ask/ or obtain a specific information that I have to go back and assess or ask the patient again. My point is , it is good to have an assessment tool like the RLT Theory proposes; to have the work done systematically with ease and tries to eliminate lapses or not assessed areas.
By: Levilaida Joy Azas
Using RLT theory, it came to my realization that when you provide
a safe environment (top priority) for the patient, everything follows. Being a nurse working on an acute area, my job calls for keeping
my patients on a safe environment by simply ensuring that there are no
obstacles where I have to do jaw thrust or chin lift due to airway obstructions
which could be a real life threatening. Dangerous and tough job as it is, I
make sure that Roper, Logan and Tierney are on my back, guiding me to make sure
that my patients are safe, breathing and alive!!!
By: Maria Lotus Aquino
Although my affiliated institution is not following Roper-Logan-Tierney theory, I realized that what I have been doing in the Surgical Unit are in accordance to the provisions of the said theory. Upon admission, patients for surgery are being assessed using the institution’s assessment tool. There’s a portion on that tool that assesses patient’s level of independence in performing different activities of living like, eating, communicating, mobilizing, eliminating, hygiene and etc. This will serve as a baseline, preoperatively, to determine the extent of impact of the surgery on the patient’s independence, postoperatively, considering the factors mentioned by the said theory and consequently the basis for providing nursing care. This determines the activities of living patients need most assistance.
Although my affiliated institution is not following Roper-Logan-Tierney theory, I realized that what I have been doing in the Surgical Unit are in accordance to the provisions of the said theory. Upon admission, patients for surgery are being assessed using the institution’s assessment tool. There’s a portion on that tool that assesses patient’s level of independence in performing different activities of living like, eating, communicating, mobilizing, eliminating, hygiene and etc. This will serve as a baseline, preoperatively, to determine the extent of impact of the surgery on the patient’s independence, postoperatively, considering the factors mentioned by the said theory and consequently the basis for providing nursing care. This determines the activities of living patients need most assistance.
By: Jessa Lorraine D. Andalan
Based on my experience as an Operating Theatre Nurse, the model helps me assess clients and give substantial report to the anesthesiologist in order for him to know if the client is fit to surgery or not before going inside the Operating Theatre. It also helps us as a surgical team to give safe and therapeutic environment to the client. Roper, Logan, Tierney's Theory provides quality health assessment tool and serves as a nursing guidelines in intervening the client. As a result, it provides quality nursing care.
By: Gina Bacud
In an ICU set-up all patients are dependent to
the nurses. Thus, it is our responsibility to help fulfill their needs and aid
them in becoming more independent. In applying the 5 factors in influencing
activities of daily living in the Roper, Logan, Tierney model of nursing, we
consider a holistic approach towards the patient. This includes biological,
pyschological, sociocultural, environmental and politico-economic. My job as an
ICU nurse is not only to attend to the physical needs of my patient, I also
have to consider other things. Our institution may not apply the Roper, Logan,
Tierney model of nursing officially, but the aspect of it, we use it all the
time as we practice nursing.
By: Arthea Corina Abe
By: Arthea Corina Abe
In my present clinic
we do assessment, health teachings and referrals to the problem being
identified. The Model of Roper-Logan-Tierney’s helps identify the area where
the person needs help through the use of twelve Activities of Living in a
checklist form. After identification of such problem, it is the nurses'
duty to focus on the problem and identify if such problem affects the other
areas as well. Being an ambulatory nurse,i have observed that the approach used
in our facility is different from other hospital approach. Referrals to the
institutions are made by the doctors according to the identified problem. And
health teachings are made to help the patient to be aware.
By: Precious Acorda
As a quality nurse coordinator, my focus of concern is making sure that standard quality nursing care is followed and provided to the patient. This is achievable through proper effective assessment during the admission and entire course of hospitalization. After carefully analyzing the RLT Theory, I came up with the idea of making proposal on how to improve the admission tool currently being practiced by recommending the theory to the Hospital’s Nursing Administration. This is beneficial to my institution as it cover all the factors required during assessment leading to a consistent care application.
By:
Kaye P.Aguilar
Nursing
theory guides nursing practice. Roper Logan Tierney’s Theory is one
of the theory that is utilized in the health care setting. In dialysis setting,
we explore the process by which long-term survivors of dialysis manage their
illness, its symptoms, and its treatment and identify common characteristics,
attitudes, beliefs, and behaviors among long-term survivors that may be related
to their long-term survival. We apply this model because from here we can
assess the activities of daily living of patient so that to provide a
comprehensive picture of an ESRD patient’s lifestyle especially with the way
they manage their fluid and diet restrictions, medications regimen, and choice
of treatment modalities thereby highlighting any problems or potential problems
which may require the focus of nursing care.
By: Kim
Aquino
I I think what we have understood here
is that assessment is not a one time task when it comes to patient care. We
should be able to use assessment all throughout the plan for us to be able to
give holistic care to our patients. This is very important specially in
out-patient clinics. Due to the non-admission nursing care we should focus more
on creating a nursing plan that results to effective and fast solution to the
problems of the patient. On this, I think that RTL theory is very useful
By:
Ann Corazon Avena
- MEDICAL ORIENTED MODEL - The Roper, Logan and Tierney model has received substantive criticism for being medically oriented and for its focus on activities of living. Tierney (1998) accepts that the model does little to ‘loosen nursing from the medical model’. However, Tierney (1998) proceeds to suggest that this may well be a particular strength of the model as it allows nursing to work hand in hand with medicine, rather than trying to separate the two. Tierney (1998) describes this as ‘reframing nursing’s relationship with medicine’.
- · Fraser (1990) was UNABLE TO FIND RESEARCH TO SUPPORT THE MODEL’S VALIDITY. A lack of ‘testing’ is another criticism of the model by Fraser. Tierney (1998) acknowledges this fact, but asserts that the model has ‘research-generating potential’.
- · Girot (1990), has accused Roper, Logan and Tierney of SIMPLICITY. This simplicity has contributed to the popularity of the model. It is widely used in the UK and Europe, has recently been included in American texts and is translated into eight other languages (Tierney, 1998), emphasizing its cultural and geographical portability.
Roper-Logan-Tierney theory has received approval from many due to its simplicity. This freedom from
complexity allows nurses to comprehend this model so easily. Also, it has been
viewed that the 12 activities of living provided by these proponents are
observable, describable and can be objectively measured that it creates a means
for nurses to properly assess and evaluate patients. According to Roper
herself, “the model provides a systematic and logical means of delivering care,
encouraging team participation leading to primary care and continuity of care.”
This model possesses clarity and consistency, provides for a holistic approach
to nursing care and recognizes nursing as an independent health-care
discipline. This model also provides a systematic framework for guiding
nursing practice and documentation. It is proven that this model is
effective in making health service more efficient especially because it is
understandable, clear, and simple. It is also easy to use and easy to translate
into practice. The model can be used in all walks of life.
Though currently used today as an
assessment tool in United Kingdom (especially in the public sector of the
Medical and Surgical setting) this model has the potential to be used not only
as a checklist but as a means to identify problems, plan care and evaluate
patients. This potential creates the need to further study this model.
Upon proper understanding of the different concepts of the model
and its purpose, we would like to recommend the use of this theory for a
holistic approach of system care to the patient not only as an assessment tool
but as a means to create a plan for the care that the patient should receive in
the course of the nursing care. We, group A has managed to study this
model created by Roper, Logan and Tierney and because this model has limited
validity tests, we also recommend that further study be done in order to
expand the great potential of this model in having a effective holistic care to
patients not only in United Kingdom but also to other parts of the world.
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REFERENCES:
The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living (Customer
Reviews)
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The Roper-Logan-Tierney
Model of Nursing: Based
on Activities of Living
Roper N,
Logan WW, Tierney AJ. The Elements of Nursing. Churchill Livingstone, 1980.
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Wimpenny P.
The meaning of models of nursing to practising nurses. Journal of Advanced
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L.(2012). Nancy Roper: Author of a model of nursing
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