Introduction

The "Roper-Logan-Tierney Model of Nursing" is a nursing theory based on activities of daily living (ADLs). It is frequently used in the UK. It was developed by Nancy Roper, Winifred W. Logan, and Alison J. Tierney. They were inspired by Virginia Henderson. This theory was set up to assess how a patient’s life has been altered due to sickness, trauma, or admittance to the hospital.

This theory characterizes what surviving means. It delves into ADLs that support maximal independence. The goal of this theory is encouraging the patient to be self-sufficient. The theory attempts to define what living means. It categorizes the discoveries into activities of living through complete assessment, which leads to interventions that support independence in areas that may be difficult for the patient to address alone. The goal of the assessment and interventions is to promote maximum independence for the patient (Roper-Logan-Tierney Model of Living, 2011). 

Authors: 

Mary Ann Santos,RN

Mariecris Sy Talosig, RN 

Biography

Nancy Roper

Nancy 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

Professor Alison J Tierney CBE

Doctor 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 recognized in the award of a CBE “for services to nursing research and education” in the 1992 Queen’s Jubilee Birthday Honors 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. 

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.
 

Author:

Cham Eldelyn Rodriguez, RN

Major Concepts: Person, Environment and Health

PERSON

In Roper-Logan-Tierney Model of Nursing, a person is viewed as an integrated individual with physiological, psychological, socio-cultural, politico-economical and spiritual components.

It is having the ability to perform the activities of daily living, which are essential that enhances the quality of life. The person is valued at all stages of the lifespan that is infancy, childhood, adolescence, adulthood, and old age.

Throughout the lifespan until adulthood, the person tends to become increasingly independent in the activities of daily living. While independence in the ADL's is valued, dependence should not diminish the dignity of the person.

A person’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 a person carries out the ADL's can fluctuate within a range of normal for that individual. When the individual is sick or unwell there maybe problems which may be, actual or potential, arises with ADL's.

During the lifespan, most individuals experience significant life events which can affect the way they carry out ADL's and may lead to problems, actual or potential.

Living is a complex process which we undertake using a number of activities that ensure 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.

There are 12 activities of daily living that were listed in the Roper-Logan-Tierney Model of Nursing. A person needs to maintain a safe environment in order to stay alive and carry out any of the other ADL. These actions may include activities such as prevention of accidents in home or driving carefully.

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 essential activity that a person performs.

It is indispensable for life itself and all other activities are therefore dependent on being able to breathe. Moreover, the person must need to eat the right food and drink the right fluids that ensure the correct balance. Many cultures have rituals and behaviors that govern activities of elimination.

A person considers it as a private activity. Personal cleansing rather than washing is also a vital activity. These activities include care of hair, nails, teeth and mouth as well as hand washing and bathing.

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.

Playing and working is an activity which depends on what lifespan the person is presently situated. A child may play while adulthood works.

Sleeping is an ADL that enables the body to relax from the stresses of everyday living and it is also during that when growth and repair of cells takes place. The list also includes death and sexuality as activities of daily living, but these are often disregarded depending on the setting and situation for the individual person.

Author: 

Maria Eleanor Santos Reyna, RN

ENVIRONMENT

According to the Roper-Logan-Tierney Model for Nursing, environmental factor is one of the five factors that influence the activities of living. The incorporation of these factors into the theory of nursing makes it a holistic model. The environmental factor in Roper's theory of nursing makes it a "green" model. The theory takes into consideration the impact of the environment on the activities of daily living, but also examines the impact of the activities of daily living on the environment.

A client’s environment includes all of the many physical and psychosocial factors that influence or affect the life and survival of the client. This broad definition of environment crosses the continuum of care for settings in which the nurse and client interact (e.g. the home, community center, school, clinic, hospital, and long-term care facility). Safety in health care settings reduces the incidence of illness and injury, prevents extended length of treatment and/or hospitalization, improves or maintains a client’s functional status, and increases the client’s sense of well-being.

A safe environment gives protection to the staff as well, allowing them to function at an optimal level. A safe environment includes meeting basic needs, reducing physical hazards, reducing the transmission of pathogens, maintaining sanitation, and controlling pollution. In addition, a safe environment is one where the threat of attack from biological, chemical, or nuclear weapons is prevented or minimized.

Basic needs: Physiological needs, including the need for sufficient oxygen, nutrition, and optimum temperature and humidity, influence a person’s safety.  Oxygen - Be aware of factors in a client’s environment that decrease amount of available oxygen. A common environmental hazard in the home is an improperly functioning heating system. A furnace that is not properly vented or a car left running inside a closed garage introduces carbon monoxide into the environment.  Nutrition – Meeting nutritional needs adequately and safely requires environmental controls and knowledge. In the home the clients need refrigerator with a freezer compartment to keep perishable foods fresh. An adequate, clean water supply is necessary for drinking and washing fresh produce and dishes. Provision for garbage collection is necessary to maintain sanitary conditions.

Physical Hazards in the environment place client at risk for accidental injury and death; we can minimize many physical hazards, especially those contributing to falls, through adequate lighting, reduction of obstacles (doormats, small rugs, wet spot, clutters), control of bathroom hazards (fall & medicine poisoning), and security measures (smoke and carbon monoxide detector instillation, No flushing of outdated medicine to toilet to prevent soil and water contamination).

Transmission of pathogen: One of the most effective methods for limiting the transmission is the medical aseptic practice of hand hygiene. Immunization can also reduce, and in some cases prevent, the transmission of disease from person to person. At community level, adequate disposal of human waste through proper construction and repair of sewers and drains controls the transmission of disease. Insect and rodent control (e.g. spraying mosquitoes) is also necessary to reduce the disease transmission.

Pollution: A healthy environment is free of pollution. It is a harmful chemical or waste material discharged into the water, soil, or air; it can also be excessive noise that presents health risk.

Terrorism: A potential environmental health threat is the possibility of bio-terrorism attack using biological, chemical, or nuclear. Although terrorist could use any agent, health official are most concerned with biological agents such as anthrax, smallpox, pneumonic plaque, and botulism.

Author:  
Renato Regalado, RN

HEALTH 

It is the degree of wellness or illness experienced by the person.  The health status of the person is dependent on ones ability to adapt to, and cope with the challenges affecting life. Roper et al identified factors that affects a person’s adaptation to illness.  These are Social factors, cultural factors, Environmental factors, and Psychological Factors.

Social Factors include the person’s economic status like poverty and problems with overcrowding


Cultural Factors are the person’s beliefs, traits, and faith which determine ones lifestyle such as food preferences

Environmental Factors are the living conditions such as water and air pollution, poor sanitation and community hazards

Psychological Factors are the person’s manifestation of past experiences in present behavior.

Author:  
Sandra Lou Razon, RN

Major Concepts:Nursing

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.

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.

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:

• 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:

• 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:

• to prevent identified potential problems with any of the ALs from becoming actual ones
• to solve identified actual problems 

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 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.

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