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Roper

Roper

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Published by dulceRN

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Published by: dulceRN on Apr 24, 2010
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01/28/2013

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The
Roper, Logan and Tierney
model of nursing (originally published in1980,and subsequently revised in1985,1990and the latest edition in 1998) is a model of nursing care based upon activities of living(ALs). It is extremely prevalent in the UnitedKingdom, particularly in the public sector 
[
]
. The model is named after theauthors - Nancy Roper, Winifred W. Logan and Alison J. Tierney.
[edit] Introduction
First developed in1980
 , thismodelis based upon work by Nancy Roper in1976. It is the most widely used nursing model in theUnited Kingdomand is particularly well used by nurses inmedicaland surgicalsettings. The model is based loosely upon the activities of daily living (ADLs) that are evolved from the work of  Virginia Hendersonin1966. Whereas The latest book edited by these women, in 2001, is the ultimate work made by them. In this book they complete the work they have been made, with an upgrade of themodel based on the new needs of the society. Although the model promotes that theassessment be used throughout the patient's care, it has become the norm in UK nursingto use the model only as a checklist on admission rather than as intended (see:modifications) 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 toillness or admission to hospital rather than as a way of planning for increasedindependence and quality of life.
[edit] Activities of living
The current model seeks to define 'what living means' (p15)
, and categorises thesediscoveries into Activities of Daily Living (ADL), in order to promote maximumindependence, through complete assessment leading to interventions that further supportindependence 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 independencein ADLs,(considering their lifespan, development, and the five key factors (see Factors below)) on a continuum ranging from complete dependence to complete independence inorder to determine what interventions will lead to increased independence as well as whatongoing support is or will be required to compensate for dependency. Its applicationrequires that it be used throughout the engagement with the patient (not only onadmission) as an approach to problems and their resolution, and as a tool to determinehow the patient can be supported to learn about, cope with, adjust and improve their ownhealth and challenges.The ADLs themselves are frequently misunderstood or are assumed to have limitedscope, leading to dissatisfcation with the model, when one fails to recognise that theADLs 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 asRoper 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"
andthat nurses in clinical practice deepend their knowledge and understanding of the modeland its application; it is essential that those using such a widespread tool be competent inits correct application.The ADLS are listed as:
Maintaining a safe environment
Mobilisation
Working and playing
Expressing sexuality 
Deathand dyingThese activities, outlining both the norm for the patient as well as any changes that mayhave resulted from current changes in condition, are assessed on admission onto a wardor 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 factorslisted) must be met as practicably as possible through supporting the patient to meet thoseneeds independently or by providing the care directly, most preferably by a combinationof 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 againstthe current care plan and giving guidance as to the level of care the patient does or mayrequire. 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 ina paternalistic environment where all care is provided for an individual even when self care is possible
[
 
]
.
[edit] Factors influencing activities of living
The following factors that affect ALs are identified 
. Nancy Roper, when interviewed by members of the Royal College of Nursing's (RCN) Association of Nursing Students atRCN Congress in 2002 in Harrogate
stated that the greatest disappointment she heldfor the use of the model in the UK was the lack of application of the five factors listed below, citing that these are the factors which make the model holistic, and that failure to
 
consider these factors means that the resulting assessment is both incomplete and flawedshe implored students to support the use of the model through promoting anunderstanding of these factors as an element of the model.These factors do not stand alone; they are used to determine the individiual's relativeindependence (and requirements to restore independence) for each othe activities of dailyliving.
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. Anexample is how having diabetes mellitus causes the person's nutritional activitiesto differ from those of a person without diabetes.
Psychological
- the impact of not only emotion, but cognition, spiritual beliefs andthe 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 incommunication; another example would be how lack of literacy could impactindependence 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 dailyliving. One example is when caring for an individual of advanced age and howsocieties expectations and assumptions about infirmity and cognitive decline,even if not present in the individual, could influence the delivery of care and levelof independence permitted by those with suffiecient authority to curtail it.
Environmental
- Roper stated in the interview above that this consideration madehers the first truly "green" model, as it recommends consideration of not only theimpact of the environment on the acitivies of daily living, but also the impact of the individual's ADLs on the environment. One example of the environmentimpacting ADLs is to consider if damp is present in one's home how that mightimpact independence in breathing (as damp can be related to breathingimpairments); another example, using the "green" application, would be howdressings that are soiled with potentially hazardous fluids should be disposed of after removal.
Politicoeconomic
- this is the impact of government, politics and the economy onADL's. Issues such as funding, government policies and programmes, state of war or violent conflict, availability and access to benefits, political reforms andgovernment targets, interest rates and availability of fundings (both pubic and private) all are considered under this factor. One example is how becoming

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