Roper-Logan-Tierney's Model for Nursing Based on a Model of Living
The Roper-Logan-Tierney Model for Nursing is a theory of nursing care based on activities of daily living, which are often abbreviated ADLs or ALs. The model is widespread in the United Kingdom, especially in the public sector. The model is named after its developers: Nancy Roper, Winifred W. Logan, and Alison J. Tierney. The inspiration comes from the work of Virginia Henderson.
The purpose of the theory is as an assessment used throughout the patient’s care. In the United Kingdom, where the model is prevalent, it has been reduced to being used simply as a checklist. It is often used to assess how the life of a patient has changed due to illness, injury, or admission to a hospital rather than as a way of planning for increasing independence and quality of life.
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.
The nurse uses the model to assess the patient’s relative independence and potential for independence in the activities of daily living. The patient’s independence is looked at on a continuum that ranges from complete dependence to complete independence. This helps the nurse determine what interventions will lead to increased independence as well as what ongoing support is needed to offset any dependency that still exists.
The activities of daily living should not be used as a checklist. Instead, Roper states they should be viewed “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 organization of her care,” and that nurses deepen their understanding of the model and its application. The patient should be assessed on admission, and his or her dependence and independence should be reviewed throughout the care plan and evaluation. By looking at changes in the dependence-independence continuum, the nurse can see whether the patient is improving or not, and make changes to the care provided based on the evidence presented.
The activities of living listed in the Roper-Logan-Tierney Model of Nursing are:
- maintaining a safe environment
- eating and drinking
- washing and dressing
- controlling temperature
- working and playing
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 patient.
According to the model, there are five factors that influence the activities of living. The incorporation of these factors into the theory of nursing makes it a holistic model. If they aren’t considered, the resulting assessment is incomplete and flawed. The factors are used to determine the individual patient’s relative independence in regards to the activities of daily living.
They are: biological, psychological, sociocultural, environmental, and politicoeconomic. The biological factor addresses the impact of the overall health, of current injury and illness, and the scope of the patient’s anatomy and physiology. The psychological factor addresses the impact of emotion, cognition, spiritual beliefs, and the ability to understand. According to Roper, this is about “knowing, thinking, hoping, feeling and believing.”
The sociocultural factor is the impact of society and culture as experienced by the individual patient. This includes expectations and values based on class and status, and culture within the sociocultural factor relates to the beliefs, expectations, and values held by the individual patient for him or herself, as well as by others pertaining to independence in and ability to carry out the activities of daily living.
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. The politicoeconomic factor is the impact of the government, politics, and economy on the activities of daily living. This factor addresses issues such as funding, government policies and programs, war or conflict, availability to benefits, political reforms, interest rates, and availability of public and private funding, among others.
Roper herself objects to the model being used as a checklist. She states that if nurses are uncomfortable discussing certain factors, they assume the patients are, as well. This leads to the nurses attributing the lack of assessment to the patient’s preference, when in actuality, the patient’s preferences were not addressed.
Her assertion leads to the conclusion that rather than deleting or disregarding activities of daily living, it can benefit the individual being assessed if the nurse uses the model more thoroughly and assesses the patient using the five factors in conjunction with the activities of daily living, regardless of the area in which the care is being received. Roper stated, “The patient is the patient, they are not a different patient because they are in a different clinical area. Their needs are the same- it’s who will meet those needs that changes.”