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The Roper-Logan-Tierney model of nursing

Williams, Bridgette C. MSN, MAMS, RN

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doi: 10.1097/01.CCN.0000508630.55033.1c
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Abstract

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Well known throughout the United Kingdom and translated into multiple languages, the Roper-Logan-Tierney (R-L-T) Model of Nursing is a practice-centered theoretical model “grounded in realism and accessibility.”1 It is useful in both academic and clinical settings. Peer-reviewed publications use aspects of the model in case studies, yet many American nurses are unfamiliar with it.2-8 This article introduces the R-L-T Model's origins, its framework, and select applications to nursing.

Pioneers of nursing theory

A British nurse and educator, Nancy Roper, devised a model to answer the question “What is nursing?”9 During the 1970s, as she pursued her graduate studies at the University of Edinburgh in Scotland, Roper found commonalities in every patient.10 In 1976, she discussed her beliefs about nursing in the publication Clinical Experience in Nurse Education.11 Roper's research was a foundation for a model centered in nursing.11 The model was refined by nurse educator Winifred Logan and nurse researcher Alison Tierney. In 1980, the three scholars published The Elements of Nursing to introduce a conceptual model that was specific to the nursing process; this was modified in subsequent editions with minimal changes in the last edition.12-14 Years later, The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living was published.1,12 This described the model of nursing and its predecessor, the model of living, to facilitate teaching and learning patient assessment and care planning, respectively.1 (See Defining terms.)

Examining the framework

The R-L-T Model of Nursing is based on five main concepts (see Visualizing the R-L-T Model of Nursing):

  • 12 activities of living (commonly called activities of daily living in the United States)
  • lifespan
  • dependence/independence continuum
  • factors influencing activities of living
  • individualizing nursing.

The activities of living are a center point of the R-L-T Model of Nursing. They prompt the use of the model to assess a patient.1

Lifespan is visualized on a continuum. Unlike the dependence-to-independence continuum, however, the arrow points in only one direction to symbolize that life only goes forward and eventually ends.1,14

In the dependence/independence continuum, the level of performance engaged by the patient is marked on a line with arrows pointing in both directions to depict her or his degree of independence.1,14

In the fourth concept, five factors influencing activities of living (biological, psychological, sociocultural, environmental, and politico-economical) are described as each impacts activities of living; these concepts are interdependent.1,14

The nursing process—assessing, planning, implementing, evaluating—is collectively depicted as individualizing nursing.1,14 The R-L-T Model of Nursing guides the nurse to assess patients' abilities in each activity within context of their lifespan, their level of dependence, and influential factors to create a plan of care.1 The plan of care identifies problems and problem-solving, structures goals, establishes the nurse's role, and encourages patient-driven care to determine effectiveness of nursing.1

The R-L-T Model of Nursing is based on several assumptions.1 First, the activities of living are a reflection of a patient's health. From birth to adulthood, each person normally performs each activity of living with increasing independence. Illness influences the patient's level of activity and all of the concepts within the model.1

Applying the theory

The R-L-T Model of Nursing applies the nursing process and serves as a guide for holistic patient assessment as a basis for a plan of care. In the clinical setting, the R-L-T Model of Nursing is applied to address research questions about specific functional deficits observed in patients needing skilled nursing care.2,6 In academia, the R-L-T Model of Nursing helps nurses develop and test a hypothesis about outcomes of patient care with a nursing framework.15

One researcher used an experimental design study to evaluate outcomes based on the method of nursing care; an intervention group of older adults was assessed and care was planned with the R-L-T Model of Nursing while the control group of older adults received “routine nursing care from clinic nurses.” The results of the study suggested better patient outcomes with the R-L-T Model of Nursing because it holistically addressed the nursing care of patients living with chronic obstructive pulmonary disease.15

In a retrospective comparative study, goal-setting for patients recovering from a brain injury was investigated.16 The researchers revised an instrument by incorporating select components of the R-L-T Model of Nursing. The inclusion of an established and systematic nursing-focused conceptual model increased the number of goals, suggesting that a holistic approach to patient-centered care planning promotes more involvement in patient care.16

In a quantitative descriptive study, researchers investigated factors that limited nurses' assessment of sexual health.17 The scholars incorporated “sexuality” from the 12 activities of living in the R-L-T Model of Nursing into the study's framework; the scholars remarked that inclusion of this component contributed to a holistic patient assessment and care plan within the nursing process.17 The findings revealed that nurse clinicians have misconceptions about patients' expectations of sexual health assessment.18

Figure
Figure:
Visualizing the R-L-T Model of Nursing

The R-L-T Model of Nursing offers a framework for holistically assessing a patient while developing a plan of care. The 12 activities of living can serve as a systematic process to assess a patient requiring complex care. In one study, the 12 activities of living were used to comprehensively assess the long-term care needs of neurologically impaired patients with an artificial airway requiring mechanical ventilation.18 Each activity of living was assessed in connection to the central focus: long-term care of a patient with a modified airway. The outcome was comprehensive guidelines that engaged the nurse to synthesize tasks with the patient's functions.18

The R-L-T Model of Nursing can also be used to promote the translation of theory into practice. In one study, the model was applied by nurse educators to help nursing students identify the active problems, goals, and interventions to address care needs for a patient.19

Ready for change?

Theory guides practice: Without applying theory, the patient and nurse's mutual goal of achieving optimal health cannot be met. As the nursing discipline adapts to changes within the U.S. healthcare system, the R-L-T Model of Nursing may facilitate increased integration of nursing theory for systematic and holistic assessment of patients and individualized plans of care.

Defining terms

  • Activities of living. Tasks and functions associated with living. The model involves 12 interdependent patient activities that may or may not occur daily in the healthcare setting.20
  • Assumption. A plausible statement believed to be true but not yet tested.21,22
  • Conceptual model. A visual depiction that describes and links expressed ideas.1,6
  • Framework. A logical structure to facilitate direction of a study associated with a discipline.21
  • Nurse theorist. A doctorally prepared professional nurse who focuses on developing and testing assumptions to explain observations of the nurse-patient relationship.20
  • Theory. Observed statement(s) to explain experiences or events based on what is known.22

REFERENCES

1. Roper N, Logan WW, Tierney AJ. The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living. Edinburgh, UK: Churchill Livingstone/Elsevier; 2000.
2. Barnett M. Using a model in the assessment and management of COPD. J Commun Nurs. 2007;21(11):4–10.
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    7. Sharpe G. Assessment of eating and drinking in a child with a gastrostomy. Br J Nurs. 2000;9(12):770–772, 774, 776-778.
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    11. Roper N. Clinical Experience in Nurse Education. Monograph No. 5. Edinburgh, UK: University of Edinburgh Department of Nursing Studies; 1976.
    12. Dopson L. Nancy Roper: author of a model for nursing. The Independent. 2014. www.independent.co.uk/news/obituaries/nancy-roper-6159941.html.
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    14. Roper N, Logan WW, Tierney AJ. The Elements of Nursing: A Model for Nursing Based on a Model of Living. 4th ed. New York, NY; Edinburgh, UK: Churchill Livingstone; 1996.
    15. Kara M. Using the Roper, Logan and Tierney model in care of people with COPD. J Clin Nurs. 2007;16(7B):223–233.
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    17. Julien JO, Thom B, Kline NE. Identification of barriers to sexual health assessment in oncology nursing practice. Oncol Nurs Forum. 2010;37(3):E186–E190.
    18. Baker M, Kakora-Shiner N. Long-term invasive mechanical ventilation for patients with neurological impairments. Br J Neurosci Nurs. 2009;5(9):409–415.
    19. Cardwell P, Corkin D, McCartan R, McCulloch A, Mullan C. Is care planning still relevant in the 21st century. Br J Nurs. 2011;20(21):1378–1382.
    20. Black BP. The science of nursing and evidence-based practice. In: Chitty KK, Black BP, eds. Professional Nursing: Concepts & Challenges. 6th ed. Maryland Heights, MO: Saunders Elsevier; 2011:253–271.
    21. Burns N, Grove SK. The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence. 6th ed. St. Louis, MO: Saunders Elsevier; 2009.
    22. Chinn PL, Kramer MK. Integrated Theory and Knowledge Development in Nursing. 8th ed. St. Louis, MO: Elsevier Mosby; 2011.
    Keywords:

    activities of living; framework; nursing process; nursing theory; R-L-T Model of Nursing

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