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Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Background of the Theorist
• 15 years as a principal tutor at a school of nursing in England and Editor for Churchill-Livingstone Publishers.
• Achieved the M. Phil. Degree.• Her thesis, Clinical Experience on Nurse Education,
became the basis for her later work on the model (Roper at a.,)
• Nursing research officer for the Scottish Home and Health development and carried out assignments for the World Health Organization (WHO).
Nancy Roper
Background of the Theorist
.
• Had her nursing education in Edinburgh, and earned an M.A in Nursing from Columbia University.
• Was a high-level position in the Department of Nursing Studies at the University of Edinburgh.
• Was a Nurse Education Officer at the Scottish Office.• Was an executive director of the International Council of
Nurses, a consultant for WHO in Malaysia, Iraq, and Europe, and directed nursing services in Abu Dhabi.
Winifred Logan
Background of the Theorist
• One of the first nurses to earn Ph. D in the United Kingdom.
• She held the position of Director of Nursing Research based in the Department of Nursing studies at the University of Edinburgh for 10 years, after which she was promoted to a personal chair in Nursing Research.
• Her work in nursing education prompted her to join with Roper and Logan as they began to develop, refine, and publish the Activities of Living Model.
Alison Tierney
• Activities of living model (ALs) were created for educational purposes following an extensive literature review covering the care of patients in hospitals and other situations.
Philosophical Underpinnings of the
Theory
• Data they gathered from clinical areas were analyzed and they determined that there was a core of common, everyday living activities.
Major Assumption, Concepts, and Relationships
Major Assumption of the R-L-T Model
Living can be described as an amalgam of activities of living (ALs).The way ALs are carried out by each person contributes to individuality in
living.
The individual is valued at all stages of lifespan.
Through the lifespan until adulthood, the majority of individuals tend to
become increasingly independent in the ALs.
While independence in the ALs is valued, dependence should not
diminish the dignity of the individual.
An individual’s knowledge about, attitudes to , and behavior related to the ALs are
influenced by a variety of factors that can be categorized broadly as biological,
psychological, sociocultural, environment , and politicoeconomic
factors.
The way in which an individual carries out the ALs can fluctuate within a range of normal for that
person.
When the individual is “ill”, there may be problems (actual of potential)
with ALs.
During the lifespan, most individuals experience significant life events or untoward event which can affect the
way they carry out ALs, and may lead to problems, actual or potential.
The concept of potential problems incorporates the promotion and maintenance of health and the
prevention of disease; and identifies the role of the nurse as a health teacher, even in illness settings.
Within a health care context, nurses and patients/clients enter into a
professional relationship whereby , whenever possible , the patient /client
continues to be an autonomous, decision making individual.
Nurses are part of multiprofessional health care team who works 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,
alleviate, or solve, or cope positively with, problems (actual or potential)
related to ALs.
Major Assumption, Concepts, and Relationships
Definition of Terms
A complex interaction of factors that people are involved in every day and are largely performed “without much conscious deliberation…. But which contribute to the complex process of living”
Activities of living
Major Assumption, Concepts, and Relationships
Definition of Terms
The progression from birth through death that influences the health of a person or population and affects most aspects of health, including health of population.
Lifespan
The Ability to perform those activities of living (ALs) throughout the lifespan; place on continuum depends on the health of the individual.
Dependence/Independence Continuum
Definition of Terms
Major Assumption, Concepts, and Relationships
Individual difference that influence the ALs and how individuals carry out the ALs; all are interrelated
Factors Influencing ALs
Definition of Terms
Major Assumption, Concepts, and Relationships
The human body’s anatomical and physiological performance
Biological
Definition of Terms
Major Assumption, Concepts, and Relationships
Elements of the person including intellectual and emotional aspects.
Psychological
Definition of Terms
Major Assumption, Concepts, and Relationships
Factors including culture, religion, spirituality, ethics, role, relationship, and status in the community.
Sociocultural
Definition of Terms
Major Assumption, Concepts, and Relationships
Factors physically external to the individual that affects all other factors.
Environmental
Definition of Terms
Major Assumption, Concepts, and Relationships
Legal, political, and/or economic factors that may be reflected in legislation
Politicoeconomics
Definition of Terms
Major Assumption, Concepts, and Relationships
The product of the interaction of the ALs with the influencing factors, dependence/Independence continuum, and lifespan.
Individuality in Living
Definition of Terms
Major Assumption, Concepts, and Relationships
The process of nursing based on the assessment of the concepts in the patient model and individualization of nursing based on logical use of the process; assessing, planning, implementing, and evaluating.
Individualizing Nursing
Definition of Terms
Major Assumption, Concepts, and Relationships
As much as possible patient should be involved in each phase of the process.
Individualizing Nursing
Definition of Terms
Major Assumption, Concepts, and Relationships
Major Assumption, Concepts, and RelationshipsConcepts
Roper et al. (2000) do not explicitly define the metaparadigm concepts of nursing: human, health, nursing and environment. However, descriptions of these concepts are found throughtout the model, defined by context.
Major Assumption, Concepts, and RelationshipsConcepts In ALs model, humans are called “Persons”. Nurses are
also persons, and they live the activities of living along with other persons. Nursing is defined by what nursing is, rather than by what nurses do. The nursing process is defined as assessing, diagnosing, treating and evaluating. Health refers to how the individual carries out the activities of living in interaction with the five factors on the dependence/independence continuum (Holland, Jenkins Solomon, & Whittman, 2004; Roper et al., 2000).
Major Assumption, Concepts, and RelationshipsConcepts Environment is one of the five influencing
factors of the model. The environment interacts with the 12 activities of living. Lifespan, dependence/independence continuum leading to individuality in living, and in the Nursing Model, to individualized nursing.
Major Assumption, Concepts, and RelationshipsConcepts Two models comprise Roper, Logan and
Tierney’s work: the living model and the nursing model. Both models are based on the core activities of living; the patient’s model of living leads to “individualized living” and the nursing model leads to “individualizing nursing”.
Major Assumption, Concepts, and Relationships
The Model of Living and Model
of Nursing
LIFESPAN
Factors Influencing Activities of living
• Biological
• Psychological
• Sociocultural
• Environmental
• Politicoeconomic
Activities of living• Maintaining a safe
environment• Communicating• Breathing• Eating and drinking• Eliminating• Personal cleansing and
dressing• Controlling body temperature• Mobilizing• Working and Playing• Expressing sexuality• Sleeping• Dying
Dependence/Independence Continuum
INDIVIDUALITY IN LIVING
LIFESPAN
Factors Influencing Activities of living
• Biological
• Psychological
• Sociocultural
• Environmental
• Politicoeconomic
Activities of living• Maintaining a safe
environment• Communicating• Breathing• Eating and drinking• Eliminating• Personal cleansing and
dressing• Controlling body temperature• Mobilizing• Working and Playing• Expressing sexuality• Sleeping• Dying
Dependence/Independence Continuum
INDIVIDUALIZING NURSING
• Assessment• Planning• Implementatio
n• Evaluation
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
The R-L-T model of nursing has been shown to be useful in many ways. Several recent articles in nursing literature describe its use in nursing practice.
Usefulness
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Usefulness Healy and Timmins
(2003)
Explained how the model was useful in organizing care for nurses working in neonatal transport.
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Usefulness O’Connor and Timmins
(2002)
Discussed how the model helped in caring for premature infants in the Neonatal ICU.
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Usefulness
Okegbenro (2002)
Determined that the model ensured comprehensiveness when planning nursing care to meet the health needs of individuals with sickle cell disease.
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Usefulness In education, the model has been widely
used in U.K. and throughout Europe. Nurse Educators in the United States are also interested in the applicability to the profession and to nursing education (Roper et al 2000).
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Usefulness
In addition, Holland, Jenkins, Solomon and Whittman (2003) have written a workbook to assist students and practicing nurse in applying the model.
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Testability The R-L-T model is testable. Indeed, as
mentioned, it was the product of testing in relation to the “core” of living (Roper et al, 2000). Because of its university, it is capable of generating middle range theories and testable hypotheses. Several research projects were identified in the nursing literature.
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Testability
Roberts (2004)
Performed a study comparing information seeking skills of nursing students from three nursing education programs and found that the R-L-T model was the most useful model for data acquisition.
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Testability Richardson and Poole
(2001)
Used the R-L-T model as a framework to develop a classification system for assessment of coping with chronic pain.
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Parsimony
The R-L-T Model of Nursing based on activities of living has logical, parsimonious construction in which two parallel models that of living and of nursing, are developed simultaneously. The models seem simple on the surface, but the reality is that the model is quite complex.
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
The model appears to be simple because it uses
everyday language, but the concepts are complex.
Simplicity
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Has criticized the related complicated documentation.
Mitchell
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Has criticized the over simplicity and lack of novelty.
Walsh
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Has criticized the over simplicity and lack of fresh
conceptualization.
Bailey
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Has criticized the preservation and status quo.
Lister
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Has indicated that it is more difficult to be simple than to
be complex.
Ruskin
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Has given an unfavorable comparison to American
models.
Parr
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Aggleton and Chalmers, Fraser, Lister, Walsh and Minschull Rose and Turner have criticized the model for being too physically oriented.
Simplicity
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
However, Girot, Newton, Page, and Parker indicated that other dimensions are possible.
Simplicity
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
The model can be adapted to any nursing situation, including but not limited to:
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Health promotion
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Health maintenance
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Prevention of disease
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
In relation to illness, acute or chronic
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
In relation to relationships
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Helping to die with dignity
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Any age group
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Irrespective of dependence or independence status
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
Irrespective of culture, social class, environmental conditions or
politicoeconomic circumstances.
Generality
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
The model initially looks simple, but the concepts are complex and may
be difficult to measure.
Emperical Precision
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
However, the concept of ALs was selected in preference to needs because ALs are observable, they can be explicitly described and in some instances, they can be objectively measured.
Emperical Precision
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Critiques
It is not necessary for a model to attempt to exhaust every aspect of a discipline. It is a guideline amenable to the creativity of the user. These models can be objectively measured.
Derivable Consequences
Roper, Logan, and Tierney: Model of Nursing Based on Activities of Living
Books of Reference
Tomey and Aligood, 5th edition, Nursing Theories and Its’ work., page 361 to 372
McEwen, M. and Wills, E. (2007). Theoretical Basis for Nursing, 2nd edition, page 181 to 186
Questions