RTL Report

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


.

• 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


• 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.


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


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


Individual difference that influence the ALs and how individuals carry out the ALs; all are interrelated

Factors Influencing ALs

Definition of Terms


The human body’s anatomical and physiological performance

Biological

Definition of Terms


Elements of the person including intellectual and emotional aspects.

Psychological

Definition of Terms


Factors including culture, religion, spirituality, ethics, role, relationship, and status in the community.

Sociocultural

Definition of Terms


Factors physically external to the individual that affects all other factors.

Environmental

Definition of Terms


Legal, political, and/or economic factors that may be reflected in legislation

Politicoeconomics

Definition of Terms


The product of the interaction of the ALs with the influencing factors, dependence/Independence continuum, and lifespan.

Individuality in Living

Definition of Terms


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


As much as possible patient should be involved in each phase of the process.

Individualizing Nursing

Definition of Terms


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”.


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


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


INDIVIDUALIZING NURSING

• Assessment• Planning• Implementatio

n• Evaluation


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


Usefulness Healy and Timmins

(2003)

Explained how the model was useful in organizing care for nurses working in neonatal transport.


Usefulness O’Connor and Timmins

(2002)

Discussed how the model helped in caring for premature infants in the Neonatal ICU.


Usefulness

Okegbenro (2002)

Determined that the model ensured comprehensiveness when planning nursing care to meet the health needs of individuals with sickle cell disease.


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).


Usefulness

In addition, Holland, Jenkins, Solomon and Whittman (2003) have written a workbook to assist students and practicing nurse in applying the model.


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.


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.


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.


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.


Critiques

The model appears to be simple because it uses

everyday language, but the concepts are complex.

Simplicity


Critiques

Has criticized the related complicated documentation.

Mitchell


Critiques

Has criticized the over simplicity and lack of novelty.

Walsh


Critiques

Has criticized the over simplicity and lack of fresh

conceptualization.

Bailey


Critiques

Has criticized the preservation and status quo.

Lister


Critiques

Has indicated that it is more difficult to be simple than to

be complex.

Ruskin


Critiques

Has given an unfavorable comparison to American

models.

Parr


Critiques

Aggleton and Chalmers, Fraser, Lister, Walsh and Minschull Rose and Turner have criticized the model for being too physically oriented.

Simplicity


Critiques

However, Girot, Newton, Page, and Parker indicated that other dimensions are possible.

Simplicity


Critiques

The model can be adapted to any nursing situation, including but not limited to:

Generality


Critiques

Health promotion

Generality


Critiques

Health maintenance

Generality


Critiques

Prevention of disease

Generality


Critiques

In relation to illness, acute or chronic

Generality


Critiques

In relation to relationships

Generality


Critiques

Helping to die with dignity

Generality


Critiques

Any age group

Generality


Critiques

Irrespective of dependence or independence status

Generality


Critiques

Irrespective of culture, social class, environmental conditions or

politicoeconomic circumstances.

Generality


Critiques

The model initially looks simple, but the concepts are complex and may

be difficult to measure.

Emperical Precision


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


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


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

Documents

RTL Report