The model assesses
the patient's level of independence in relation to the activities of living, which
then helps the nurse and health care team to develop a nursing care plan based
on the patient's individual abilities and levels of independence. To be most
effective, the patient should be assessed upon admission, as well as evaluated
throughout care. That way, changes can be made to the care plan, if needed.
Although these
activities are individually identified in reality when using the model to
assess a patient more than one can be assessed - for example eating, drinking
is linked to eliminating and breathing.
The following table provides prompts to enable you to assess each activity.
The following table provides prompts to enable you to assess each activity.
NURSING PROCESS
In the "Model of
Nursing", the five components can be used to describe the individual in relation
to maintaining health, preventing disease, coping during periods of sickness
and rehabilitation, coping positively during periods of chronic ill health, and
coping when dying. Individualizing nursing is accomplished by using the process
of nursing, which involves four phases: (1) assessing, (2) planning, (3)
implementing, and (4) evaluating. The process is simply a method of logical
thinking, and it should be used with an explicit nursing model.
The patient’s individuality in living must be born in mind during all four phases of the process. This model has been used as a guide for nursing practice, research and education.
The patient’s individuality in living must be born in mind during all four phases of the process. This model has been used as a guide for nursing practice, research and education.
ASSESSMENT
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 cyclical activity rather than a "once only". They use the word to include:
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 cyclical 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 problems with ADL's
- identifying priorities among problems
HOW
THE INFORMATION IS GAINED:
The main data (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 unconscious, and a "second-hand information" thus become very important in helping the nurse and others to plan the care.
SOURCES OF DATA ARE:
The main data (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 unconscious, and a "second-hand information" thus become very important in helping the nurse and others to plan the care.
SOURCES OF DATA ARE:
- patient
- family
- significant others
- health care professionals
- patient records/nursing notes
As with the research process, observation
and interview are the 2 key methods of obtaining information. Observation of a
patient however must be systematic in order 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.
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: 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.)
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. Whenever feasible, a time/date should be specified alongside a goal to indicate when evaluation should be undertaken".(Roper et al 19996, p.57)
The objective of the plan is:
( Note: 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.)
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. Whenever feasible, a time/date should be specified alongside a goal to indicate when evaluation should be undertaken".(Roper et al 19996, p.57)
The objective of the plan is:
- to prevent identified potential problems with any of the ALs from becoming actual ones
- to solve identified actual problems
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 drawing 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.
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.
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.
Authors:
Marie Grace Taccayan,RN
In
my current medical setting we used to do different appraisal and 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.
Authors:
John Michael Saclolo, RN
John Michael Saclolo, RN