This essay will discuss the framework of Roper, Logan and Tierney with regard to a holistic assessment of a child whom I have cared for while on placement. I will include a detailed explanation of the holistic assessment; I carried out for both the child and family under my care. A comparison of other nursing frameworks will be given using evidence based literature to support findings, alongside with the ward nurses opinions and view. Confidentially and anonymity will be maintained throughout the essay. A reflection of my findings will also be provided within the conclusion .Finally, a rational of why this framework is a choice for nursing practice will also be discussed that also related to my practice placement.
The roper, Logan and Tierney nursing model is widely used in practice areas around the UK to teach students how to link nursing theories and practice together in-order to deliver the best care possible for patients/clients (Holland et al 2008). This model was the first to be published by British nurses in 1980 and has become increasingly known around the world (Pearson et al 2005).The model consist of five main concepts which are Activities of daily living (AL), Factors influencing activities of living, individuality in living, lifespan and dependence/independence continuum (Roper et al 2000). The model uses the activity of daily living (AL) to assess patient holistically using twelve activities which are maintaining a safe environment, Communication, Breathing, Eating and drinking, Elimination, Personal cleansing and dressing, Controlling body temperature, Mobilising, Sleeping, Expressing Sexually and Dying. Factors which influence a person AL are physical/biological, socio-cultures, environmental and politico economic factors (). The concept of lifespan concerns with the whole person from birth to death (), for example the stages includes infancy, childhood, adolescence and adult (ref) are factors which influence a person AL. Individuality in living relates to how a person carries out a AL, that may be due to their lifespan, independence/dependence, biological, socio-cultural, environment and politico economic factors. Dependence/independence is linked to the lifespan and how a person is able to carry out their AL ().
This model was chosen because they had read and tired many other models which was less appropriate for their clients therefore Roper-Logan-Tierney was through to be more appropriate to meet the needs of their clients’ has the model was invented in Britain base on experience gathered in the Uk , on like other models which was base on American Healthcare settings therefore the RLT model was through to better suited with assist the nurses with the needs of their patients/client. The nurses on the ward all agreed the RLT model was very efficient with assessing a patient and in their opinion was the best they had ever use and they have been many, however they also said at the beginning of using the model they did not like it has it was through to be more work load and unnecessary has they get a estimate of a 100 patient a week on their ward but it does covers everything regarding assessments of a patient. The RLT model was commented has especially well for paediatric settings.
The model combines both living and nursing, which together can be very complex but in doing so has made the model relatively simple and understandable to nurses/student, whilst maintaining the relevance to nursing practice (Roper et al 2000).
The roper-Logan-Tierney is The Activities of daily living was used to holistically assess a child I cared for on placement, it involves assessing twelve activities of daily living which is seen as the core of the model (Holland et al 2008), each activity is examine individually but are all inter-twine for example eating and drinking cannot be considered without elimination or existence. They are simple different aspect of our being and without one activity functioning has normal due to illness may affect another activity (Holland et al 2008). The holistic assessment begins with:
For confidentiality purposes, patient will be referred to as Tobby and his mother as Pam (NMC, 2008). Tobby was a two year old boy admitted to the ward with Pam who is self employed electrician. Pam gave consent to use Tobby’s medical records in this essay. Tobby has two sisters who reside abroad and two brothers aged 19 and 17 from his mother side living at home with X in a flat. X Mum has notice X has not been quit himself for 3days, with the lost of weight and occasional sweating with Fever.
Breathing, temperature control and circulation
On admission Tobby had a respiratory rate 30, which was the maximum rate for a child of this age (glasper, 2007). He had a temperature of 36.2 degrees which was below normal (Glasper et.al, 2007) for his age, normal temperature range between 37-37.2 degress (ref). Saturation of 98% in air (ref) and his Pulse rate was 125 which was normal (Glasper et al, 2007) Pam reported Tobby had fever in the past days.
Mobility, development, communication and safe environment
Tobby’s movements limited due to the abdominal pains often stood for a short while before sitting, unlike before where he was able to walk, run unaided. Although he was in pain Tobby was able to respond to instructions from Pam this was appropriate behaviour for his age (Davies, 2004), and able to voice his thoughts and feeling this behaviour was age appropriate (Davies, 2004)
Eating and drinking
Tobby was on normal diet which consisted of solids and liquids but never ate pork due to religious belief. His diet is age appropriate according to (ref).Tobby often loved his food and fruits. However in the past days he had lost appetite for food. This may have resulted in weight loss (ref) as Pam had noticed. He weighted 15.5kg on admission which was a decrease in his weight before of 18.7kg based on his age children tend to loss at this stage due to more activities (ref) but it can be coupled with loss of appetite (ref).
Elimination and urinalysis
Pam reported that Tobby normally passes urine four times a day which is below normal for his age (ref) the average urine output for a two year old is between 5-8 times a day (ref). Tobby had bowel movements containing mucus for the past two days, mucus stool is not normal at any age but is a indication of ulcerative colitis or crohn’s disease (Nicol et al, 2008)
Sleeping and playing
Tobby normally sleeps at 2200hours when Pam returns from work, however since being unwell he has been sleepy much of the time. He was a bit quite, played with his blue track and watched the children’s television channel while holding his soft toy called iggle piggle which seem to comfort him when going to sleep. (Ref whether this is age appropriate)
Cleaning, dressing and sexuality
Tobby was dressed in warm clean white and blue jeans, Pam seemed to be nurturing Tobby IN masculine way with blue jeans and truck, a colour mainly associated with males (ref). He had a pale skin complexion.
Psychological state/pain discomfort
Tobby has always been a happy, independent, playful and interactive child, this was appropriate behaviour based on his age (ref). However on admission Tobby was crying and appeared to be in pain looked unsettle, grunting and complained of pain in his right side of the abdomen. Pam seemed worried but was trying to remain calm by comforting Tobby by gently rubbing his abdomen and stroking his hair, which seemed to smoothen him for short periods. Pam commented that it had become a battle to get Tobby to eat for the past days and this seemed Pam was stressed.
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The OREM model was first published in 1971 by Dorothea Orem and based on nurses helping patient/client to care for them, to recover more quickly and holistically due to performing their own self care (Pearson et al, 2005). OREM consists of three main theories: theory of nursing describe as maintaining the health of a individual who’s unable provide the care necessary to preserve life and health (Moules et al, 2008), theory of self-care deflect is where nursing care is require by a patient because they are incapable or limited to provide self-care and theory of self-care base on individuals performing their own care with the maturity to be consistent, control, effective with purposeful action (Pearson et al 2005).
The model can be used for patient at different level of dependence but is criticise has more health promotion and prevention due to the emphasis on individuals being responsible for their own health care and not enough on the contributing factor of a person social structure which contributes to health(Pearson et al 2005). The AL can also be used for all age groups but is through to be a more appropriate model rather OREM model for children as it recognise the facts that a individual physical, psychological, environmental, socio-culture and the lifespan also impacts on a person health but is criticise for not considering the family ability to assist the child to independence therefore would be difficult in a family-centred care (Moules et al, 2008).
The OREM model may be seen has a radical approach to healthcare due to the focus on nurses, enabling clients to make their own decision and care for themselves when possible however the hospital can reduce patients independence; by not allowing patients/clients their medical record without using the process of freedom of information Act which may seem difficult to patient and reluctant to do so. Many may comment that this examples is out dated but ask yourself how many patient has access to their medication are encourage to read their medical or nursing record before coming to your own conclusion ((Pearson et al 2005). Whereas the AL focus on the nurse ability to prevent, comfort and promote patient independence it was criticise many nurses has simplistic and also by many author as medically bias because the AL relates more to physiological systems but was dined has some of the AL does refer to psychological aspects (Moules et al, 2008).
AL use within England has increase but there was no literatures to support it use outside the UK (Moules et al, 2008) whereas the OREM model was still being widely used both in American and England showing it is still effective in assessing patients/clients() but was criticise has drawing assumption, that everyone wants to be in control of their health within society, with no mention of those with no desire or motivation to do so or of nurses working within nursing homes that may prefer clients to remain dependent on staff. Orem model was also criticise has Tortuous and jargonistic regarding the language/writing style used (Moules et al, 2008).
AL and OREM model both aim to see patients/clients has individuals with different need and ability, using their experience has nurses to achieve a patient focus assessment tool but has done so in different ways which may have been due to the fact that they working in different countries. As a student nurse it great have a variety of nursing model to learn from and has open the door for nurses/student nurses around the world to care for patient/client of all ages and has left me hopeful future will bring fought a model compose of both AL and OREM or a more effective model for patient that can be used in every setting within the healthcare. This research has given me an in-depth knowledge of nursing models which will help me in the future to become a better nurse as I am more able to holistically assess a patient/client appropriately. This insight will help the author in future practice, has her knowledge of nursing framework as increase with regards to meeting clients/patient needs and completing nursing documentation more efficiently.
-Davis, D. (2004) Child development: A practitioner’s guide. 2 edn. New York: The Guilford press
-Glasper, A, L., McEwing, G., and Richardson, J. (2007) Children’s and young people’s nursing. New York: Oxford university press
-Nicol, M., Bavin, B., Cronin, P., Rawlings-Anderson, K.(2008) Essential nursing skills. 3edn. London: Mosby
-Roper,N., Logan,w., Tierney, J, A. (2000) The Roper Logan Tierney:Model of nursing. London: Churchill Livingstone
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