Рөпер, Логан және Тирнидің күтім моделі: Ұлыбританиядағы қолданылуы мен кемшіліктері

The Roper, Logan and Tierney model of nursing (originally published in 1980, and subsequently revised in 1985, 1990, 1998 and the latest edition in 2000) is a model of nursing care based on activities of living (ALs). It is extremely prevalent in the United Kingdom, particularly in the public sector. The model is named after the authors – Nancy Roper, Winifred W. Logan and Alison J. Tierney

First developed in 1980, this model is based upon work by Nancy Roper in 1976. It is the most widely used nursing model in the United Kingdom. The model is based loosely upon the activities of daily living that evolved from the work of Virginia Henderson in 1966. The latest book edited by these women 2001 is their culminating and completing work, in which they upgrade their model based on their view of societal needs. The original purpose of the model was to be an assessment used throughout the patient's care, but it has become the norm in UK nursing to use it only as a checklist on admission. It is often used to assess how a patient's life has changed due to illness or admission to hospital rather than as a way of planning for increased independence and quality of life.

The following factors that affect ALs are identified. Nancy Roper, when interviewed by members of the Royal College of Nursing's (RCN) Association of Nursing Students at RCN Congress in 2002 in Harrogate stated that the greatest disappointment she held for the use of the model in the UK was the lack of application of the five factors listed below, citing that these are the factors which make the model holistic, and that failure to consider these factors means that the resulting assessment is both incomplete and flawed. She implored students to support the use of the model through promoting an understanding of these factors as an element of the model. These factors do not stand alone; they are used to determine the individual's relative independence (and requirements to restore independence) for each other activities of daily living. Biological the impact of overall health, of current illness or injury, and the scope of the individual's anatomy and physiology all are considered under this aspect. An example is how having diabetes mellitus causes the person's nutritional activities to differ from those of a person without diabetes. Psychological the impact of not only emotion, but cognition, spiritual beliefs and the ability to understand. Roper explained this was about "knowing, thinking, hoping, feeling and believing". One example of the application of this factor would be how having paranoid thoughts might influence independence in communication; another example would be how lack of literacy could impact independence in health promotion. Sociocultural the impact of society and culture experienced by the individual. Expectations and values based on (perceived or actual) social class or status, or related to the individual's perceived or actual health or ability to carry our activities of daily living. Culture within this factor relates to the beliefs, expectations and values held by the individual both for themselves and by others pertaining to their independence in and ability to carry out activities of daily living. One example is when caring for an individual of advanced age and how societies expectations and assumptions about infirmity and cognitive decline, even if not present in the individual, could influence the delivery of care and level of independence permitted by those with sufficient authority to curtail it. Environmental Roper stated in the interview above that this consideration made hers the first truly "green" model, as it recommends consideration of not only the impact of the environment on the activities of daily living, but also the impact of the individual's ALs on the environment. One example of the environment impacting ALs is to consider if damp is present in one's home how that might impact independence in breathing (as damp can be related to breathing impairments); another example, using the "green" application, would be how dressings that are soiled with potentially hazardous fluids should be disposed of after removal. Politicoeconomic – this is the impact of government, politics and the economy on ALs. Issues such as funding, government policies and programmes, state of war or violent conflict, availability and access to benefits, political reforms and government targets, interest rates and availability of fundings (both public and private) all are considered under this factor. One example is how becoming eligible for housing benefit might impact a person's independence, especially if the current housing is poor or inadequate; another example is how living in a place where violence and conflict are the norm would impact the ability to self care.

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 lifespan continuum begins at conception, others that it begins at birth.

Within short stay settings such as surgery or in areas where the assessor is uncomfortable with or unsure of the applicability of certain activities of daily living (ADL) it is common for the activities 'sexuality' and 'death' (as well as others) to be disregarded. These modifications depend upon the institution or the nurse and often results from a lack of understanding of the application of, or the factors within, the model. This is unfortunate, because this limits the application of the model and thereby reduces its efficacy. Often clinical settings use a list of the activities of daily living as an assessment document, without any reference to the other elements of the model; Roper herself rejected the use of the list of ADLs as a "checklist" as she stated that it was essential not simply to read the title of the ADL, but to base assessment on knowledge of the scope of the ADL as assessed using the 5 key factors.