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