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Roper Logan & Tierney Adls

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The model of nursing that I will use for this assignment was originally developed by Roper in 1976. It was then added and updated in 1980, 1981 and 1983 by Roper, Logan & Tierney. The Roper (1996) model offers a framework for nurses so they can check credit is taken into account when undertaking any nursing care plan.

There are four main stages of the nursing process as identified by Yaura & Walsh (1978) *

* Assessment

* Planning,

* Implementation

* Evaluation

During any assessment the nurse's goal is to determine what the patient can & can not do and link that to the activities of daily living (ADL). They will also take into consideration any environmental factors that might affect the individual and their ability to carry out ADLs.

The objective in this model of nursing is to be able to identify the patient's individual needs & lifestyle, and to make a decision on any potential problems related to carrying out ADLs for that person. This model of nursing has been used in a number of different settings the 12 activities of daily living are related to basic human needs. The 12 activities are:

* Maintain a safe environment

* Communication

* Breathing

* Eating & drinking

* Mobilisation

* Working & playing

* Elimination

* Washing & Dressing

* Controlling Temperature

* Expressing sexuality

* Sleeping

* Dying

In order to maintain patient confidentiality and for the purpose of this assignment, certain personal details of the essay (Care Plan) have been omitted, such as patient name. This is done in accordance with nursing midwifery code of professional conduct (2007) guidelines so I shall use an alias name in the essay (Care Plan) and the patient shall be referred to as Mrs Cullan.

In this assignment I shall look at how I, as a student nurse, can make a care plan in relation to one of the 12 activities of daily living. I shall focus on communication for this assignment.

Mrs Cullan was a patient, coming into a day procedure unit for cataract extraction surgery, and I followed the patient from admission, into theatre and then into recovery. The patient involved is a 78 year old female; she is a widow and lives alone but has relatives who live near her. She has worn glasses since she was a young girl but lately she has noticed difficulty reading & watching TV, this was in despite of the fact that she had received a new lens prescription. Mrs Cullan also found that she had to stop driving at nights as she was appearing to have some trouble seeing due to the lights from oncoming traffic.

Mrs Cullen's observational skills where all within normal limits on admission BP 130/80 pulse was 80bpm and respirations 16. She is taking 325mg of aspirin, as she has a history of TIA from 3 years ago, and Mrs Cullen is also taking 40mg of fluoxetine because she has been suffering from depression since her husband died. It is necessary to help alleviate any concern for this patient.

The establishment of this health care plan is related to the anticipated surgery for Mrs Cullan. In order to receive this procedure, therefore it is essential that the patient must be able to lie flat for around 20-40 minutes. Movement is a key activity of daily living & the effects of not being able to move, perhaps following an injury, or illness can have a significant impact on an individual and whether they can have his type of surgery.

The Roper Logan and Tierney type of nursing would suggest that the daily activities of living can be used as a tool when carrying out an assessment of the patient's needs. This would require me, as a student nurse, and the patient discussing the goals, outcomes and correct implementation for the patient.

Although Mrs Cullan was particularly concerned about having the procedure, she was still committed to support the operation as cataracts will have a significant effect on a person's quality of life & this was causing her some trouble. She had noticed deterioration in her eye sight & the increasing trouble with reading or watching TV, along with this it was having an impact on her other daily activities.

Due to Mrs Cullan's initial trepidation, I was acutely aware of my non-verbal, as well as my verbal, communication. Egan (2002) states that patients can take cues from non-verbal communication and they can tell if the nurse has an interest in them, so it is essential that the nurse is attentive to your patient thus allowing the patient to open up and trust you more. An example of non- verbal communication skills that can be practiced is given with the acronym SOLER:

* Sit squarely

* Open posture

* Lean forward

* Eye contact

* Relatively relaxed (Egan 2002)

"Human beings are essentially social beings and a major part of living involves communicating with people in a variety of different ways. Communicating not only involves the use of verbal language as in talking but also the non-verbal transmission of information by facial expression and body gesture." Roper (1996) (p.21)

I explained to Mrs Cullan that even though cataract surgery is now seen as a generally safe and common practice there is a small risk of infection as with any operation. It is essential that your patient is aware of this, so they can make an informed decision. Mrs Cullan was advised on how to look out for any signs of infection and what to do if she experienced any redness, pain or discharge from the eye. Mrs Cullan gave her permission for the procedure after she had received some support & reassurance.

Communication is essential throughout this assessment & after the procedure as your patient is perhaps feeling frightened, confused and worried. It is also necessary to provide the patient the total amount of information regarding the procedure. Therefore this can be done by asking the patient how



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