I. Application to Nursing Practice

Being in the community, having the knowledge of Roper-Logan-Tierney model is a very good foundation. As many public health providers state, we see the real picture, the real situation of our people, the root of the emergence of certain disease, their environment, their thoughts, their physical components. Through the model, we could assess their ability of doing the ADLs and from that; we could derive nursing diagnosis and devise plan of care. Also, having in mind the factors that may influence their ability to do ADLs, as a public health service, the approach is more holistically for we cannot just based the decision of nursing care by immediate needs of clients.

- Shzerylle Ivy O. Agellon, RN

Being a nurse entails tremendous amount of responsibility when taking care of a sick patient. My job as nurse became more exciting and challenging when I started to work in a remote area in Abu Dhabi. Using Roper–Logan–Tierney Model of Nursing, it has been said that providing a safe environment for the patient is the top priority when providing care to the patient and comes together with the other 11 activities, some of which are essential such as breathing and others that which enhance the quality of life.

When I say remote area, it is really that remote that you need to take four hours drive plus 2 hours boat ride before reaching our area. It is a primary hospital catering to the needs of local people who chose to live their lives in the island as if it wasn’t changed by modern influences. We lack doctors and facilities that are needed for extremely sick patients. So with that, we are used to the “referral system” wherein we refer and transfer our patients out of the island when they become seriously ill and requires at least secondary level of care. As a nurse, I became one of the escorts sending patient via ambulance to our receiving facility. I have to make sure that safety measures are being carried out during the transport aside from preparing the needed equipment, machines and medication prior to transport. Because it is useless to have everything in hand but you don’t have a safe environment to start working with. I am making sure that ambulance trolley is working properly and secure the patient safely on the stretcher. Safety first before anything else. In this manner, I can expect a smooth transport to the receiving hospital and I can still provide the holistic care the patient needs even if we are traveling. 

                                                     

                                                         - Rose Angele  Amores, RN

Caliraya Resort Club Inc. is 7.6 hectares of lush greenery that offers fun-filled activities which surely provide fond memories for both learning institutions and family gatherings. (http://www.caliraya.net )Caliraya Resort Club Inc.  offers Team building activities like Wall Climbing, Rappelling, Obstacles course, Earth Ball (8 feet by diameter) and others. These team building activities require bursting energy. Teams will compete against each other. They will be playing a game similar to a volleyball game except that they will be using an 8-foot ball. Alternate service is applied regardless who wins the serve. Teamwork, communication, participation and cooperation are needed.

Before we allow the guest to use the Earth Ball, our assigned martial explains the necessary precaution to be observed while using the said facility. In some instances, some of our guests get injured in Earth Ball due to its size. Ankle sprain is the most case I handled. I always practice the RICE acronym in treating my patient. Rest to eliminate further injury. Ice compress to eliminate further inflammation. Compress to and Elevate to reduce blood and fluid flow to the affected region of the body causing edema.

Applying the Roper-Logan-Tierney Theory, I should always do the RICE treatment for my patients so that they can still enjoy their stay in the resort and they can still use the other facilities that not requiring bursting energy even though they have mild injury.

                                                   - Eduardo Araojo, RN

Anyone  coming to operating room assume  that their life is  endangers.

Roper –Logan  and Teirney Theory  guide us Peri-operative nurses to develop  a nursing care plan base upon the ADL-Activity of daily living. Peri-operative nurses facilitate the patient to achieve our goal during Pre-Operative and Post Operative visit  It support the patient to relieved their anxiety ,and understand what to expect during and after the operation,  we  gained patient cooperation to reduce Post operative complication. The patient be able performed an independent function immediately after the operation.

                                        - Luz Alilin, RN

The Roper-Logan-Tierney Theory on Activities of Daily Living is observed and practiced in my area which is Adult Cardiology Ward. Being sick puts us in a state wherein we become dependent or semi-dependent in terms of our Activities of Daily Living from mobilization to washing and bathing. At the start of each shift we have this Adult Re-assessment form, a general checklist that contains safety checklist, physical assessment, and ADL of an individual. It works like a plot wherein you can see the progress of an individual from needs assistance by 2 persons to self caring. The theory also guides us in planning care for our patient by maximizing their potential to function independently like encouraging them to take a bath on their own and from bed rest to sitting down in chair. These may be simple activities but it is these activities which matter in order to have a quality life in a day to day basis. As they said, let’s go back to the basics.

                                                           - Danna Alcudia, RN

Working with the Security Forces is neither a shaggy-dog story nor a tall tale, you have to balance between your profession and the "confidentiality" of the security system as a whole. anytime you will be pulled out from the area you assigned and reassign you sometimes somewhere in the middle of the barren and arid region- the desert, at anytime for a month or two. However, by applying this theory, it is easier for me to adjust the things that need to be done first. It really helps me often to assess how a soldier's life has changed due to illness and/or transferring or admitting to hospital rather than as a way of planning for increased independence and quality of life. All these soldier's Activities of Living eases and facilitate my professional nursing approach and organize my care.

                
                                                              - Marben Asari, RN


The Roper, Logan, Tierney model centers on the patient as an individual and his relationship with the five components:  Biological , Psychological , Sociocultural, Environmental, Politico-economic.  Each individual is different and according to them ‘this individuality can be seen to be a product of the influence on the activities of all the other components and the complete interaction between them.  Having this theory in mind, each patient is unique and each of them requires different nursing management.
In our unit – Critical /Intensive Care Unit, most of the patients, requires full support on AL by nurse because most of them are sedated and ventilated.  However, during weaning from the ventilator and sedations, we carefully assess and provide appropriate nursing care and management based on their needs until they become fully independent with activities of living.  In providing care with this patients, we have to consider holistic approach which means not just attending their physical needs and supporting  AL but also considering other components to achieve independence and to maintain good quality of life.

                                                                                                 - Xy za Araque, RN

         A typical shift in our pediatric emergency is having 3 staff nurses per duty and a doctor. One staff nurse will be in the triage area, the other two will handle the observation, short-stay and resuscitation area. The number of the patients we have for a 24-hour shift range from 150-200 children. Imagine how many infants and children, we have to deal with in one shift. So assessing properly a child and asking information from the parents or guardians are essential for us to have focus in the planning of care. Language barrier is the most common problem that we encounter in assessing a patient. The good thing about it is, eventually, the nurses slowly learn the basics of Arabic, Malayalam and Urdu to be able to understand and cope up what the patient or the parents are complaining. From the Triage we assess, until seen by the doctor, if sent to the observation area, another assessment will be done but by this time it is focused assessment for each affected system. And once the patient is admitted, another assessment will be done inside the ward. I the ward, every shift patient is assessed again, to monitor the improvement or unchanging condition. Assessment is vital for us. As what our doctors here always say, their eyes, ears, and hands are from the nurses, without the nurses they will be debilitated.

                                                      -          Dayang Jasmin Alcantara, RN

Several factors affect nursing and the deli very of nursing care. Roper Logan Tierney Theory though not that frequently, I can say it is also being used in my workplace. Working in a service ward catering 25 patients in a shift I can say that proper assessment during initial ward round is very important. The theory helps me in assessing patients and addressing their needs.  It gives me an idea that providing a safe environment is an important aspect in patient important. A ward especially a charity ward set up is very chaotic and stressful, and providing a therapeutic environment is a challenge for me. Having a much bigger nurse-patient ratio assessing the level of independence of the patient helps me prioritize who needs care first.  It is also my duty to prevent potential problems of my patient, alleviate their problems and prevent recurrent of their problems. I do have a big role and understanding the theory makes me a more efficient provider of nursing care here in our setting.

                                      -          Reynaldo Alipen, RN

In the beginning, I always think application of nursing in my work area is not always observed by most of nurses. Later on I realized that all nursing cares that were being provided by all the nurses in different specialties are relevant to the concepts of different nursing theories.
Being a nurse assigned in Operating Room in one of the hospital here in KSA,  the concept  of ALs' theory is said to be very common pre-operative and post-operative. Knowing that patients who are subject for surgeries may have emotional and physical issues. Most of the patients verbalizes that they are nervous prior to surgery. Because of this, patients usually feel cold. Providing warm blanket and simply telling the patient to take a deep breath will help to subside the discomfort the patient feels.
Socio-cultural factors is one to be considered in order to provide optimal care to a patient. It’s the culture of people here in KSA that female to male conversation is prohibited unless necessary. Here, female patient is always comfortable to communicate and express her feelings to female nurses. Female patients are most likely to be dependent to female nurses. Sometimes husband of the patient also request females only to assist them like transferring from stretcher to OR bed, putting the ECG leads, giving oxygen and even attending the surgery.  Also insertion of IFC should be done by the same gender of a nurse and a patient. These are the things that we are considering in my work area in order to provide a comfortable environment to patient.

                            -          Jhima Asprer, RN