A Short Clip - The Contributors

A. The Theorists

THEORIST'S BACKGROUND & INSTITUTIONAL AFFILIATION

Nancy Roper

• Roper started the nursing career which she had always determined to follow as a schoolgirl in Wetheral near Carlisle, she studied to be a registered sick children's nurse (gaining a gold medal at Booth Hall Hospital, Manchester), and then took her general training (collecting more medals at Leeds General Infirmary).

• In 1943, when Roper became a state registered nurse, several of the nurse teaching staff had been called up as members of the Territorial Army, although teaching was a reserved occupation. She was offered a post as staff nurse in teaching. She gained a London University sister tutor's diploma in 1950.

• Nancy Roper achieved MPhil degree in 1970 at Edinburgh University, wrote thesis on “Clinical Experience in Nurse Education” which later became the model of Activities of Living.

• Worked as the first nursing research officer for the Scottish Home And Heath Department (McEwen & Wills, 2011).

• Carried out assignments for World Health Organization (WHO) European Office.

• Worked as a nurse educator and speaker.

Winifred Logan

• Winifred Logan earned an M.A.  In nursing from Columbia University in 1966.

• She was appointed as Nurse Education Officer at the Scottish Office in 1960’s -1970’s.

• Her Assignment as executive director of the International Council of Nurses, a consultant for WHO in Malaysia, Europe, and Iraq (McEwen & Wills, 2011).

• She established nursing services in Abu Dhabi.

Allison Tierney

• Alison Tierney was one of the first nurses to earn a PhD in the United Kingdom. 

• Director of Nursing Research at the University of Edinburgh for 10 years later promoted as a personal chair in nursing research (McEwen & Wills, 2011).

• She joined Roper and Logan as they began to develop, refine, and publish the Activities of Living (ALs) model.

• She contributed to the development of research in nursing in the United Kingdom and throughout Europe.

B. Philosophical Backgrounds

ALS THEORY: PHILOSOPHICAL BACKGROUND

• ALs model was created for educational purposes after an extensive research review from clinical data’s, which were analyzed and determined for caring patients in hospitals and other situations (McEwen & Wills, 2011).

• Formulated in Universally recognized language, English (McEwen & Wills, 2011).

• The research revealed that the common core of nursing related to patients everyday living activities (Scott, 2004).

• These findings culminated in the creation of the first organized frame work for nursing knowledge and the emergence of a problem solving approach to individualized patient care (Scott, 2004). That is Nancy Roper's legacy to nursing.  

Nursing During 1970's & 1980's

 1970s and 1980s: The popularity and acceptance of nurse-midwifery increased dramatically (American college, n.d.) 

• 1970s: Nursing home scandals (Nickolsen, 2012). 

• 1971: The National Black Nurses Association and the American Assembly for Men in Nursing are established. The Miller Amendment on nursing homes (Nickolsen, 2012). 

• 1971 - The hospice movement is established in the United States when Florence Wald and her associates found Hospice, Inc (Paralumun, n.d.).

• 1973: The North American Nursing Diagnosis is founded (Nickolsen, 2012).

• 1973: ANA developed and published the first Standards of Nursing Practice (Matthews, 2012). 

• 1975: The National Association of Hispanic Nurses is founded (Nickolsen, 2012).

• 1979: Jean Watson known for her Theory of Human/Trans-personal Caring (American college, n.d.).

• 1980: ANA developed and published the first Nursing: A Social Policy Statement (Matthews, 2012).

• 1980 - The Roper, Logan and Tierney model of nursing, based upon the activities of daily living, is published (Paralumun, n.d.)

• 1987:  ANA developed and published the first Scope of Nursing Practice (Matthews, 2012).

C. Major Concepts

MAN

• Viewed as integrated individual with physiological, psychological, socio-cultural, politico-economical and spiritual components.

• Having the ability to perform the activity of daily living which are essential such as breathing and others that which enhance the quality of life.

NURSING

• An interpersonal process by which the professional nurse practitioner assesses the patient’s level of independence related to the activity of daily living which then helps the nurse and the health care team to develop a nursing care plan base on the client’s abilities and level of independence.

• Has a responsibility to help the client do their ADL’s dependently into complete independence.

ENVIRONMENT

• Environment interacts with 12 ALs, lifespan, dependence /independence continuum contributing to individuality in living and nursing.

HEALTH

• Health refers to how individual carry out the ALs.

D. Assumptions

MAJOR ASSUMPTIONS OF ALS THEORY

Carried out by each individual and valued at all stages of life span

• Dependence should not diminish the dignity of individual while gaining the independence (McEwen & Wills, 2011).

• An individual’s knowledge, attitude, and behaviors are influenced by bio-psycho-sociocultural, environmental, and politico-economic factors.

• An individual illness may be classified as actual or potential.

• Nurse educates an individual on promotion and maintenance of health and prevention of diseases.

• Professional relationship between nurse and patient helps patients to make autonomous decisions (McEwen & Wills, 2011).

• Nurses are considered as a part of multi professional heath care team to benefit the patient and the community.

E. Major Concepts in ALs Theory

• Three major concepts of model are ALs, lifespan, and dependence/independence continuum.

• Factors influencing ALs are biological, psychological, sociocultural, environmental, and politico-economic.

• Humans and nurses are referred as person (McEwen & Wills, 2011).

• Model is based on nursing theory which includes assessing, diagnosing, treating, and evaluating

1. Activities of Living (ALs)

There are 12 activities, some of which are essential such as breathing and others that which enhance the quality of life (McEwen & Wills, 2011).

1.    Maintaining a safe environment

2.    Communication

3.    Breathing

4.    Eating and drinking

5.    Elimination

6.    Washing and dressing

7.    Controlling temperature

8.    Mobilization

9.    Working and playing

10.  Expressing sexuality

11.  Sleeping

12.  Death and dying

Factors Influencing Activities of Living

• Biological
• Psychological
• Sociocultural
• Environmental
• Politico-economic (McEwen & Wills, 2011)

Major Relationships Between Concepts in Theory

Graphic Depiction of ALs Theory

2. Life span continuum

• The model also incorporates a life span continuum, where the individual passes from fully dependent at birth, to fully independent in the midlife, and returns to fully dependent in their old age/after death. Some researchers argue that the life span continuum begins at conception, others that it begins at birth

• Roper et.al. 1996 p.23, As a person moves along the lifespan there is a continuous change and every aspect of living is influenced by the biological, psychological, socio-cultural, environmental and politico-economic circumstances encountered throughout life. 5 stages of life:

1 .Infancy

2. Childhood

3. Adolescence

4. Adulthood

5. Old age

 3.  Dependence / Independence

This component of the model is closely related to the lifespan and to the ALs. It is included to acknowledge that there are stages of the lifespan when a person cannot yet ( or for various reasons can no longer ) perform certain ALs independently. Each person could be said to have a dependence/independence continuum for each AL.

F. Nursing Process

Assessment

What components are needed for a successful assessment

·       Good communication

·       A systematic approach to data collection

·       Interpretation based on nursing knowledge

Objective (scientific Quantitative)

·       Empirics measurement of knowledge with scientific fact

Subjective (Art, Qualitative)

·       Aesthetics gained through empathy and is how a nurse becomes sensitive to a patient’ s pain,worry or joy

·       Ethics concerned with motivation, morality, human rights and law

·       Personal knowledge awareness that the nurse has an impact on patient care

Sources of Data

1. Non verbal observation

·       Sight - Physical, psychological (and social)

·       Touch – Skin, temp, hydration, pulse/BP

·       Sound – Breath wheeze, stridor

·       Smell - breath

·       body fluids infections, gangrene 

2. Verbal Communication

·       Patients/ clients

·       Family and friends (Meaningful others)

·       Nursing colleagues

·       Medical colleagues

·       Other members of multidisciplinary team

3. Written records

·       G.P Letter

·       Transfer letter

·       Old notes

Communication

Why are good communication skills required?

·       To establish and maintain a relationship with patients and their families

·       To encourage patients to describe all relevant aspects of their problems

·       To get and give accurate information

·       To use time and opportunity effectively

·       To improve patient satisfaction with the care given

·       To improve thrust and cooperation with the care

·       To reduce negative emotions and fear

Guide to a successful assessment

·       Prepare adequately

·       Introduce yourself - prepare patient

·       Use nonverbal communication

·       Be courteous

·       Use sensitivity, compassion and empathy

·       Use focused questions (opened and closed)

·       Listen

·       Clarify

·       Summarise what they describe

·       Make notes

Planning

Effective planning depends on the quality and comprehensiveness of the assessment

·       Determine the problems

·       Establish the risks and priorities – How ill are they?

·       Can they breath adequately (safe airway?)

·       Are they in pain? (physical/ psychological)

·       Can they maintain a safe environment? If not why not? (Drugs, drink, mental or psychological problem?)

·       Noncompliance with medical advice

Writing a care plan (s)

Think about

·       Who is it for ?(The patient and other members of nursing team)

·       What are the short term and long term goals?

·       How can you determine that you have reached the goals? (measurable)

·       How will the patient know he/she has achieved the goals? (realistic)

·       Who is involved in the delivery of the care? (The patient (and family), yourself, the nursing team, medical staff, multidisciplinary team, labs, investigations, procedures etc)

·       How quickly is the problem likely to change – How soon will you need to reevaluate the plan?

·       How many problems are there? - Which order of priority?

·       How can you prove that they are evidence based (what resources do you need?) (core care plans Vs

·       individualized ones)

Implementing

a) At the start of the shift, during handover and when you first meet them, think about whether the oral report matches the patients actual condition

b) Compare this to what you already know of the patient and to the existing care plans

c) Has anything changed for better or worse

d) Decide:

What are the priorities for looking after this patient?

• Is their condition stable? What observations

need doing how often

• Are they going off the ward tests/investigations/operations

• Are they being discharged? When are they going? Is every thing ready?

Repeat this process for all the patients you are looking after.

e) What routine work must be done and when should this be done

f) Who is going to do this work are you on your own or do you have a Clinical support worker with you? How will they give you feedback?

g) Who is available to give you help or advice if needed? (senior nurse medical team)

h) How are you going to organize the work - TIME MANAGEMENT

i) What resources do you need?

Evaluation

MENTAL - On going throughout implementation

WRITTEN -  (this should preferably be done with the patient present in order to get accurate feedback)

·       Must be carried out at least twice in 24 hours

·       And whenever any incident occurs. (date, time

signature)

·       Write a general statement about patient’s condition

(better, same, worse)

·       Evaluate each care plan in turn and by number

·       Personalize - use patient’s own words appropriate

·       State what care you have given “C are of planned” or any variation/ comment e.g. “pressure area care given skin slightly red on …sacrum”

·       Amend the care plan if circumstances have changed

·       Discontinue care plans if the goal(s) have been reached

·       Legally- if the care given has not been recorded than it hasn’t occurred!