INTRODUCTION FOR GROUP A

1. INTRODUCTION FOR GROUP A

2. The art of nursing has been characterised by a humanistic philosophy which values personal meaning, subjectivity and understanding. At the same time, in attempts to become scientific, there has been an acceptance of notions of science which are primarily based in a positivistic, empirico-analytical paradigm. • JF Playle (1995) • So many models, so little testing • •Barnum (1998) appealed for systematic intervention, but difficult to do this at broader level of theory • •Nursing theories fail Karl Popper’s test of falsifiability • •Theories emphasising interpersonal function of nursing (e.g. Peplau) are durable and applicable to diverse practice situations • •Caring is phenomenological whole greater than sum of parts • •Comprehensive theory encompasses art and science of nursing, with humanistic principles at core • •Beware notion that practices with best evidence are best practices. • Roper, Logan and Tierney model of nursing lies in the well-known hierarchy of human needs identified by the psychologist Abraham Maslow (1954)  and inspired by the works of Henderson.This theory has been widely used in the UK, Ireland and within European countries.If a theory like this has been used and adapted to the health care system, would this mean that this is the best among the rest??

3. BIOGRAPHY OF THE THEORISTS

4. 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.Biography and Career of Nancy RoperNancy Roper was born on September 29, 1918 in Wetheral, Cumberland.Her mother was a nanny, and when Roper started her career after life-long plans to become a nurse, she studied to be a registered sick children's nurse. She then took her general training. It was during her training that she began to develop her nursing model.In 1943, she became a state registered nurse and was offered a post as a staff nurse in teaching. When she was later offered a senior tutor position at Cumberland Infirmary, Roper insisted on qualifying as a teacher first. She earned a sister tutor's diploma in 1950 from London University, and started overseas experience with a Royal College of Nursing study tour to Belgium in 1954.She was an examiner for the General Nursing Council, and worked on updating Oakes' Dictionary for Nurses, which appeared in 1961. After 30 years as a nurse and nurse educator, Roper became a self-employed lexicographer and author in 1964.Roper began her investigation into the concept of a core of nursing in her studies at Edinburgh University in 1970, thanks to a British Commonwealth Nurses Fellowship, which led to the initial publication of her model of nursing.Roper passed away in Edinburgh on October 5, 2004. Nancy Roper's Contribution to Nursing Theory: Roper-Logan-Tierney Model of Nursing

5. Professor Alison J Tierney CBEDoctor of Nursing Alison Tierney is Editor-in-Chief of Journal of Advanced Nursing. JAN is an international journal that publishes research and scholarly work across the breadth of nursing and midwifery, and it is in the ‘top ten’ nursing journals worldwide.  Alison herself has published widely in the course of her career in nursing research and education.  She was based for almost 30 years in the University of Edinburgh in Scotland (UK), including 10 years as Director of the Nursing Research Unit, and finally as Professor of Nursing Research and Head of the Department of Nursing Studies.  She then worked at the University of Adelaide in South Australia as Professor and Head of Clinical Nursing, now an Adjunct Professor,  and she continues to be involved  in a range of research- and healthcare-related activities in the UK and internationally. Alison was the UK (RCN) representative on WENR from 1990 to 1997 and in her final year she was Chair of the Steering Group. Alison Tierney’s contributions to the nursing profession were recognised in the award of a CBE “for services to nursing research and education” in the 1992 Queen’s Jubilee Birthday Honours List.  Alison Tierney’s extensive publications reflect her various contributions over time to nursing scholarship and nursing research and, through her membership over the years of numerous steering groups and committees, she has contributed actively to the strategic development of research in nursing, both nationally and internationally. 

6. Winefred Logan Winefred Logan has a wide experience of being a nurse internationally and a nurse educator. In 1950, she was exposed in the tuberculosis/thoracic unit in Canada with foreign patients who experienced culture shock. With that, Logan realized the importance of biological, psychological, sociocultural and environmental factors in giving nursing care. In 1960’s, she got her master’s degree in Columbia University, New York. After that, she returned to become a teaching staff in the Department of Nursing Studies  at the University of Edinburgh in 1962. She also became a WHO Consultant, as executive director of International Council of Nurses. With her interests in conceptual model of nursing, she didn’t hesitate to accept the invitation of Roper to develop a nursing model based on model of living.

7. Introduction: Theorists: Nancy Roper, Winifred W. Logan and Alison J. Tierney One of the widely used nursing model in the United Kingdom. Also referred as a Human Needs Model A model of nursing care based on activities of daily living (ADLs). Theory Sources: Virginia Henderson Roper, Logan and Tierney model of nursing lies in the well-known hierarchy of human needs identified by the psychologist Abraham Maslow (1954). If a theory like this has been used and adapted to the health care system, would this mean that this is the best among the rest??

8. Roper, Logan, and Tierney model A model for nursing that emphasizes the importance of the patient's ability to perform activities of daily living. Individuals are seen as being engaged in various activities of living throughout their lifespan; during their lives they will fluctuate between total independence and total dependence, according to age, circumstance, and health status. Nursing should provide assistance with these activities when needed.

9. First developed in1980, this model is based upon work by Nancy Roper in1976. Uses the model only as a checklist on admission rather than as intended as an approach to the assessment and ongoing care of an individual. It is often used as a way of comparing how a patient's life has changed due to illness or admission to hospital rather than as a way of planning for increased independence and quality of life.

10. Limitations: • The ALs themselves are frequently misunderstood or are assumed to have limited scope, leading to dissatisfaction with the model, when one fails to recognise that the ALs are more complex than the title would lead one to believe. For this reason, it is not recommended in the model that it be used as a checklist, but rather as Roper states "As a cognitive approach to the assessment and care of the patient, not on paper as a list of boxes, but in the nurse's approach to and organisation of her care" and that nurses in clinical practice deepen their knowledge and understanding of the model and its application; it is essential that those using such a widespread tool be competent in its correct application.

11. 5 COMPONENTS (CONCEPTS) IN THE MODEL 1. Activities of Living 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), in order to promote maximum independence, through complete assessment leading to interventions that further 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. Its application requires that it be used throughout the engagement with the patient (not only on admission) as an approach to problems and their resolution, and as a tool to determine how the patient can be supported to learn about, cope with, adjust and improve their own health and challenges. The ADLs themselves are frequently misunderstood or are assumed to have limited scope, leading to dissatisfaction with the model, when one fails to recognize that the reason, it is not recommended in the model that it be used as a checklist, but rather as Roper states "As a cognitive approach to the assessment and care of the patient, not on paper as a list of boxes, but in the nurse's approach to and organization of her care” and that nurses in clinical practice deepened their knowledge and understanding of the model and its application; it is essential that those using such a widespread tool be competent in its correct application.

12. These activities, outlining both the norm for the patient as well as any changes that may have resulted from current changes in condition, are assessed on admission onto a ward or service, and are reviewed as the patient progresses and as the care plan evolves. To provide effective care, all of the patient's needs (which are determined by assessing the patient's specific abilities and preferences relative to each activity, based on the factors listed) must be met as practicably as possible through supporting the patient to meet those needs independently or by providing the care directly, most preferably by a combination of the two 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. It is not effective in a paternalistic environment where all care is provided for an individual even when self care is possible.

13. There are 12 activities, some of which are essential such as breathing and others that which enhance the quality of life. Maintaining a safe environment •Communication •Breathing •Eating and drinking •Elimination •Washing and dressing •Controlling temperature •Mobilization •Working and playing •Expressing sexuality •Sleeping •Death and dying

14. 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. Communication-Roper st al (1996) Human beings are essentially social beings and a major part of living involves communicating 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. 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. 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 . Elimination- Eliminating , like eating and drinking is influenced by sociocultural factors. Many cultures have rituals and behaviors that govern these activities and eliminating is a private activity.

15. 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. Controlling temperature- Human beings are able to maintain their internal body temperature at a constant level due to a heat regulation system, but extremes in external temperatures can cause this to endanger normal living. Mobilisation-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.

16. Working and playing- Working for most people offers a way of obtaining income to support how they live. 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. 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 ) Death and Dying-It is the process of dying that is included.

17. 2. Factors influencing activities of living • Biological • -The impact overall health, of current illness or injury, and the scope of the individual's anatomy and physiology all are considered under this aspect. An example is how having diabetes mellitus causes the person's nutritional activities to differ from those of a person without diabetes. • Psychological • - The impact of not only emotion, but cognition, spiritual beliefs and the ability to understand. Roper explained this was about "knowing, thinking ,hoping, feeling and believing". One example of the application of this factor would be how having paranoid thoughts might influence independence in communication; another example would be how lack of literacy could impact independence in health promotion. • Sociocultural • - The impact of society and culture experienced by the individual. Expectations and values based on (perceived or actual) social class or status, or related to the individual's perceived or actual health or ability to carry our activities of daily living. Culture within this factor relates to the beliefs, expectations and values held by the individual both for themselves and by others pertaining to their independence in and ability to carry out activities of daily living. One example is when caring for an individual of advanced age and how societies expectations and assumptions about infirmity and cognitive decline, even if not present in the individual, could influence the delivery of care and level of independence permitted by those with sufficient authority to curtail it. • •

18. Environmental - Roper stated in the interview above that this consideration made hers the first truly "green" model, as it recommends consideration of not only the impact of the environment on the activities of daily living, but also the impact of the individual's ADLs on the environment. One example of the environment impacting ADLs is to consider if damp is present in one's home how that might impact independence in breathing (as damp can be related to breathing impairments); another example, using the "green" application, would be how dressings that are soiled with potentially hazardous fluids should be disposed of after removal. Politico economic - This is the impact of government, politics and the economy on ADL's. Issues such as funding, government policies and programmes, state of war or violent conflict, availability and access to benefits, political reforms and government targets, interest rates and availability of fundings (both pubic and private) all are considered under this factor. One example is how becoming eligible for housing benefit might impact a person's independence, especially if the current housing is poor or inadequate; another example is how living in a place where violence and conflict are the norm would impact the ability to self care.

19. 3.The life span continuum • 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 p.23- 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 ife: • 1.Infancy • 2.Childhood • 3.Adolescence • 4.Adulthood • 5.Old age

20. 4.Dependence/Independence This component of the model is closely related to the lifespan and to the ALs. It is included to acknowledge that there are stages of the lifespan when a person cannot yet ( or for various reasons can no longer ) perform certain ALs independently. Each person could be said to have a dependence/independence continuum for each AL.

21. 5.Individuality in living Each individual will experience and carryout the Als differently. Each person’s individuality in carrying out the AL’s in part, determined by stage on the lifespan, and degree of dependence/independence and is further fashioned by the influence of various biological, psychological, socio-cultural, environmental and politico-economic factors.

22. ROPER, LOGAN AND TIERNEY THEORY in individualizing nursing care and the nursing process: • Each patient is unique, as is 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. Inorder 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. • The NURSING PROCESS is a systematic approach to planning and delivering nursing care. Yura and Walsh (1978) identified 4 main stages of this process, namely: • Assessment • Planning • Implementation • Evaluation • Arets and Morle(1995) offer the following definition of the nursing process: "The nursing process is an analytic problem-solving method whereby the attainment of the pre-determined nursing goals by means of chosen nursing care strategies is attempted through a systematic application of the assessment, problem idetification, planning, implementation and evaluation"(Arets and Morle 1995, p.311). • In the USA, the term problem identification is very often used instead as nursing diagnosis. • Roper et al (2000, p.124) point out that although the word "ASSESSMENT" has generally been adopted for the first phase of the process of nursing, their view is that the word "assessing" should be encouraged as it implies a more cylical activity rather than a "once only".They use the word to include: • collecting information about or from a person • reviewing the collected information • identifying the person's probles with ADL's • identifying priorities among problems • HOW IS THE INFORMATION BE GAINED?

23. The main date(information) comes from the patient whenever possible(primary source) and any other data, for example relatives, is a secondary source.It may not be possible however to obtain first-hand information from the patient e.g. if they were unconcious, and a "second-hand information" thus become very important in helping the nurse amd others to plan the care. • SOURCES OF DATA ARE: • patient • family • significant others • health care professionals • patient records/nursing notes • Data can be collected in a number of ways, but whenever data are obtained. it is essential that the nurse ensures confidentiality in keeping with their professional code of conduct and that any recorded data are protected (DATA PROTECTION ACT 1998). • As with the research process, observation and interview are the 2 key methods of obtaining information.Observation of a patient however must be systematic inorder to ensure that nothing is missed.It is this framework of  Roper,Logan and Tierney model for nursing became the essential tool. Other means of obtaining data are physical examination of the patient, informal discussion with the patient, family and significant others and medical records. Objective date are essentially those which can be observed and measured, while subjective data are how the patient defines and reports their own experience.

24. EVALUATION • Any care planned and implemented must have some outcome if it is to be worthwhile in terms of benefiting patients. Evaluating care also provides a basis for ongoing assessment and planning as the person's circumstances and problems change. (Roper et al 2000,p. 141). It is the opportunity for the nurses to evaluate whether the care they have managed and delivered themselves has been effective in meeting the goals that were set by them or by the patient.

25. IMPLEMENTING • This is the 3rd stage of the nursing process and is evidence of how the nurse intervenes to solve the actual or potential problems the patient/client may experience. The nurse plans and carries out the interventions by drwaing upon a range of knowledge, skills and expertise in caring for patients in her own field of practice.An interesting example of how the Roper et al model for nursing was used to assess, plan and implement care in a very different environment to that of a WESTERN HOSPITAL is seen in Heslop's (1991) care study of a sick Tibetan child(Tenzin) in a refugee settlement in Northern India. She used the model to work with the child's father(Sonam) to identify  Tenzin's actual problems, discuss management related to the problems and reassess them following implementation of the planned care. Despite the treatment and care however, Tenzin eventually died from the diagnosed poliomyelitis but because of the collaborative approach between the nurse and the parents, he was surrounded by his family at home.

26. PLANNING • Care is planned according to the nature of the actual or potential problems identified. and is dependent on the nurses' knowledge of appropriate care to be given for that health problem and taking account of the individuality of the patient. • According to Roper et al (2000, p.137) the objective of the plan is: • to prevent identified potential problems with any of the ADL's from becoming actual ones • to solve identified actual problems • where possible to alleviate those that cannot be solved • to help the person cope positively with those problems that cannot be alleviated or solved • to prevent recurrence of a treated problem • to help the person to be comfortable and pain-free as possible when death is inevitable • To achieve the plan, it requires the nurse and the individual to set goals, both short term and long term for the actual and potential problems identified. For example: If the patient has a raised blood pressure requiring medication, it is the nurse's task to ensure that the patient receives that at the appropriate times and in accordance with the doctor's prescription.On the other hand, if the patient is very anxious about his blood pressure, it could be their goal to try and reduce this anxiety by voicing their concerns and talking through any other activities they may have with the nurse. • ( Note for my classmates: Roper, Logan and Tierney theory is not only focusing to the nurses but it is also a nurse-patient centered theory just like what it is stated above.This is only for the enlightenment of everybodyMy references are dated 1996 till 2005.) • Roper et al(1996) point out these: • "goals should be achievable within the person's individual circumstances otherwise there is a danger of disheartenment.Whenever possible, goals should be stated in terms of outcome which are able to be observed, measured and tested so that their subsequent evaluation can be accomplished. Wheneverr feasible, a time/date should be specified alongside a goal to indicate when evaluation should be undertaken".(Roper et al 19996, p.57)

27. PLANNING • The oobjective of the plan is: • -to prevent identified potential problems with any of the Als from becoming actual ones • -to solve identified actual problems • -where possible to alleviate those that cann

28. Sample Assessment Tool

32. Application to Nursing Practice- • In my present clinic we used to do assessment, health teachings and referrals to the problem being identified. The Model of Roper-Logan-Tierney’s help identify the area which the person needs help, Using the twelve Activities of Living as a tool in a checklist form. After identification of such problem, it is the nurse duty to focus on the problem and identify if such problem causes or affect the others as well. As an ambulatory Nurse, the approach is different as it is in the hospitals. 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

33. 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. • Biological factor. This is considered in relation to the type of surgery being performed—may it be gastric, renal, urologic, orthopaedic, or EENT(eyes, ears, nose, throat) in nature. This has something to do with its effect on the activities of living. For instance, gastric surgeries have major effect on the patients’ eating pattern and elimination. Patients with status post gastric-related procedures such as cholecystectomy, appendectomy and the likes, are given general liquids first, then progress to soft diet and full diet as the peristalsis resumed, as evidenced by passing out of gas and positive bowel moment. I make sure that I put the instructions on the communication board and have coordinated with dietician to ensure that the correct food is being served. Moreover, patients are encouraged to increase oral fluid intake to maintain hydration. Renal and urologic affect the patients’ urination (elimination), thus accurate measurement of Intake and Output is a must. Orthopaedic cases have an impact on patients’ mobility. Thus, confining them on bed with Balkan frame is indeed a big help as they can lift themselves up and turn to sides, making it easier for the nurses to assist them. Different types of assistive devices are also given to them by the rehab department. Oral or EENT affect communication as well as eating pattern. Per my experience, status post thyroidectomy is often required to have voice rest. With that, other means of communication are used to allow patients to air their concerns such as sign language, body gestures, writing in paper and etc. Furthermore, postoperative patients need to be taught of doing deep breathing exercises at least 10x every hour (waking hours) to prevent pulmonary complications such as atelectasis or pneumonia. Temperature is also monitored and controlled within normal. In hygiene assistance, patients are given bedbath if they too weak to bathe in the bathroom and assisted in dressing up. But once able to ambulate, patients are encouraged to bathe in the bathroom as independently as possible and making sure that dressing on postoperative site are waterproof (Opsite or tegaderm). Moreover, dressings are changed daily or every other day to prevent infection. In other words, all type of surgeries has an effect on the patients’ activities of living in one way or another.

34. Psychological Factor. This factor is important especially when communicating to patients and giving important instructions. Age, cognition, and emotion status of the patients are put into consideration when approaching them. Based on experience, postoperative patients are the most obedient to the nurses’ instructions, as they feel that they are in the most vulnerable state. Per experience, geriatric patients need to be communicated in a loud (louder than usual), clear voice and be given short, simple sentences as instructions and patiently, repeating information as necessary (in consideration to cognition). The cognitive level is considered as to the timing of giving instructions. Immediate post-operative patients are usually groggy after surgery as the effect of anaesthesia subsides. Instructions then are delayed until patients are fully awake. Moreover, in terms of emotional status, pain is the most common complaint of patients. Thus, pain must be intervened first and the patient’s level of comfort be considered before patients cooperate with the planned activities. • Sociocultural. Working in this institution makes me feel working abroad. Patients vary—from Asians, Africans, Guamanians, to Western nationalities.  Thus I am also exposed to different cultures and have practiced my respect, tolerance and sensitivity to these differences. Westerns want nurses to be assertive and to explain to them every detail of your action. In terms of carrying out activities of living, they prefer to do it on their own, with little assistance from the nurses. Asians prefer nurses to speak to them in low-toned voice. They rarely ask questions and often follow nurses’ instruction without objection. Asians also are more dependent to the nurse in doing activities of daily living. Moreover, nurses coordinate with the dietary department regarding patients’ food preferences. • Environment. Maintaining safe environment is an important consideration in providing care to patients. Postoperative patients feel groggy after the surgery. Thus to prevent falls or injury, bedside rails are kept up at all times and bed is placed in the lowest position possible. Moreover, lights are left open at night to prevent accidents in case patient will use the bathroom. Floors are kept dry and sidebars can be found along the walls of the bathroom. Moreover, as patients have contraptions, I make sure that these are kept untangled and organized to prevent causing injury. In addition, sleep and rest are encouraged for the patients to gain their energy. Thus, environmental modifications are made to make it more conducive to sleep such as dimming the light and setting the room temperature right. • Politicoeconomic. Most of the patients confined in our institution belong to the higher bracket of the society. Thus their demands are also greater. They want nursing service not less than the best. Moreover, they are very fortunate to have the luxury of supplies, medications and therapies (rehabilitation) for them to be able to get back to their preoperative level of independence in the shortest time possible. • This is how I am able to put into practice the Roper-Logan-Tierney theory in practice. • -Jessa Lorraine D. Andalan, RN

35. INTERVIEW conducted by :Ms. Lotus

36. Roper et al (1996, p.34) made the ff. assumptions in relation to their theory and model: • Living can be described as an amalgam of Activities of Living. • The way ADL's are carried out by each person contributes to individuality in living. • The individual is valued at all stages of the lifespan. • Throughout the lifespan until adulthood, the individual tends to become increasingly independent in the ADL's. • While independence in the ADL's is valued, dependence should not diminish the dignity of the individual. • An individual's knowledge, attitudes and behavior related to ADL's are influenced by a variety of factors which can be categorized broadly as biological, psychological, sociocultural, environmental and politico-economic factors. • The way in which an individual carries out the ADL's can fluctuate within a range of normal for that person. • When the individual is "ill" there maybe problems (actual or potential) with ADL's. • During the lifespan, most individuals experience significant life events which can affect the way they carry out AD'L's and may lead to problems, actual or potential. • The concept of potential problem incorporates the promotion and maintenance of health, and the prevention of the disease, and identifies the role of nurse as a health teacher, even in illness settings. • Within a health care context, nurses work in partnership with the client/patient who, except for special circumstances, is an autonomous, decision-making person. • Nurses are part of a multi-professional health care team, who work in partnership for the benefit of the client/patient and for the health of the community. • The specific function of nursing is to assist the individual to prevent, aleaviate or solve, or cope positively with problems(actual or potential) related to ADL. • Reference: Holland, K., Jenkins, J., Solomon, J. & Whittam, S.Applying the Roper.Logan.Tierney."Model In Practice".2003.Churchill Livingstone.London

37. TESTIMONIALS •  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 infant. This contribution may be considered under the following headings: • 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. • 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. • Educational preparation - For practising nurses the implementation of models may represent a significant change in practice.

38. 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. • 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. • G. O’ Connor (2002) acknowledges that the model provides a systematic framework for guiding nursing practice and documentation in the neonatal setting, although further testing of this model may be required in practice.

39. By  • Mr L H Gelling • This review is from: The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living (Paperback) • The Roper-Logan-Tierney model of nursing has undoubtedly had a major impact on nursing in the United Kingdom, across Europe and throughout the world. This stimulating and concise monograph draws together and describes much of Nancy Roper's, Winifred Logan's and Alison Tierney's collaborative thinking from before the publication of the Elements of Nursing, in 1980, until the publication of the fourth edition, in 1996, and beyond. They review how the model evolved and the changes that occurred to the text over subsequent editions. • The authors describe this text as their final account of the model but they emphasize the continually changing nature of nursing and that the model will require further assessment and revision. The final chapter concludes with the suggestion that although this will be the esteemed trios' final contribution it may not be the final version of the model. Interestingly, in the final chapter the authors undertake a debate into the value, role and relevance of nursing models to the 21st century.

40. This is the authors' final account and critique of their well-known model, which student nurses and students of nurse theory will find invaluable. Using the five elements of their model, the authors clarify their views on what are now known as the metaparadigms of nursing: person, health, environment and nursing. An evaluation of the model is for me the most interesting. The authors address various academic critiques of their model and remind us that it was created as a learning tool for students rather than as grand theory. 

Perhaps the Roper Logan Tierney model has been more misused than used. There has been an over-emphasis on the activities of living at the expense of concepts about individualizing nursing care. But it is certainly the best-known and most widely used model in this country. These authors have made an enormous contribution to British nursing. The future of nursing models in practice may be uncertain, but there is no doubt about their importance in the development of nursing theory and the evolution of professional nursing. • Review by: Annie Chellel RGN, RNT, DipN, MA, BSc(Hons), BA(Hons) • Reference: http://nursingstandard.rcnpublishing.co.uk/reviews/book-reviews/review-the-roper-logan-tierney-model-of-nursing

41. Criticisms of the model • From the outside, the general view of the Roper-Logan-Tierney model appears to be positively balanced. Outright condemnation of the model has been rare, at least in published form. One of the earliest and most publicised attacks on the model was by a medical consultant (Mitchell 1984; see also Tierney 1984 ) although, in fact, it was its overly complicated documentation which was his concern and, indeed, it was the nursing process that he was primarily exercised about. In contrast, the fiercest single criticism from within nursing berates the over simplicity of the model (Walsh 1991). Its lack of novelty has also been criticized: Lister (1991) believes that this model allows nurses to preserve the status quo and does not provide a new perspective on nursing activity or challenge entrenched viewpoints. • ).

42. Medical orientation - 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’. In addition, Tierney also questions whether models ‘can, and should, be tested’ (Tierney, 1998). • 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), emphasising its cultural and geographical portability.

43. RECOMMENDATION   This  Model of Nursing  presented by  Roper, Logan and Tierney  is widely used and applied in the UK  especially in the public sector of the Medical and Surgical setting.  As this Theory of Nursing is based upon activities of Living ( ALs) which  evolved upon the Theory of Virginia Henderson, then the entirety of the theory is not that difficult to understand and implement. ADLs are defined as "the things we normally do...such as feeding ourselves, bathing, dressing, grooming, work, homemaking, and leisure".            The Theory focuses on the patient as an individual  and his relationship with the five (5) dimensions: physiological, psychosocial,  socio cultural, politico-economical and environmental.           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.”          One critique of the model reveals that the Roper, Logan and Tierney model possesses clarity and consistency, provides for a holistic approach to nursing care and recognizes nursing as an independent health-care discipline. The model provides a systematic framework for guiding nursing practice and documentation.         I would recommend the use of this theory for a holistic approach of system care to the patient.

44. CONCLUSION • The model provides a systematic and logical means of delivering care, encouraging team participation leading to primary care and continuity of care abolishing the 1960’s task allocation style of nursing (Roper et al, 1996). • Adapting Roper-Logan-Tierney’s Model into practice is not difficult, for the reason that 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. It only shows how the model works in different settings. How easily it can be incorporated into the practice. • The model illustrates the impact of Activity of Living, and the connection of one activity to another. It also explained how nursing should be done into practice. Roper identified nursing as helping people to prevent, alleviate, or solve, or cope positively with problems related to activities of living. It is not only recognizing the existing problem but also preventing the potential problems.

45. REFERENCES http://books.google.co.uk/books/about/The_Roper_Logan_Tierney_Model_of_Nursing.html?id=RJ21IkAZQQ4C Roper N, Logan WW, Tierney AJ. The Elements of Nursing. Churchill Livingstone, 1980. Roper N, Logan W and Tierney A. The elements of nursing 4th ed. Edinburgh: Churchill Livingstone, 1996. Wimpenny P. The meaning of models of nursing to practising nurses. Journal of Advanced Nursing 40(3), 346–354, 2002. http://nursing-theory.org/nursing-theorists/Nancy-Roper.php Dopson, L.(2012). Nancy Roper: Author of a model of nursing. http://www.independent.co.uk/news/obituaries/nancy-roper-6159941.html McLellan, A. (2008)Nursing Champions. Nursing Times vol 104 No. 49. http://www.nursingtimes.net/Binaries/0-4-1/4-1943965.pdf Österreichischer Gesundheits Un Krankenflege-Verbrand. http://www.oegkv.at/index.php?id=3888 Roper, N., Logan, W., Tierney, A. (2001). The Roper Logan Tierney Model of Nursing: Based on Activities of Living. Churchill Livingstone Publications. Pgs 10-11. Reference: http://www.nursingtimes.net/nursing-practice/199604.article  REFERENCE: http://www.cmft.nhs.uk/directorates/mentor/documents/Assessingplanningimplementingandevaluatingcare_001.pdf Reference: http://nursingstandard.rcnpublishing.co.uk/reviews/book-reviews/review-the-roper-logan-tierney-model-of-nursing REFERENCE: http://www.amazon.co.uk/product-reviews/0443063737 REFERENCE: http://asheehan.brinkster.net/nursing/downloads/articles/Nursing%20models%20-%20extant%20or%20extinct%20--%20Tierney.html#61

46. Aggleton, P. & Chalmers, H. "Nursing Models and Nursing Practice". 2nd edition.1996, 2000.Macmillan Press LTD.London • Holland,K., Jenkins, J., Solomon,J. & Whittam, S.:"Applying the Roper.Logan.Tierney". Model In Practice.2005.Churchill Livingstone.London