The nursing process and nursing models

Whilst the nursing process offers a systematic way of looking at care delivery, on its own it is not particularly useful as it does not give any indication as to what to assess. It indicates that care should be planned, implemented and evaluated but again offers little direction as to how to do this. Consequently a number of practitioners and nurse theorists have offered theoretical frameworks or models. One such model is the ‘Activities of Living Model’, proposed by Nancy Roper, Winifred Logan and Alison Tierney (1996). Basing their ideas on previous work by Maslow (1958) and Virginia Henderson (1960), and Nancy Roper herself,
Roper, Logan and Tierney set out to describe what they believed everyday living involves for individuals, and from this identify the necessary components of nursing. In very simple terms their model can be summarized as consisting of four components, which all contribute to individuality in living, namely (1) the lifespan continuum from conception to death; (2) 12 activities of living (listed below); (3) five factors that influence each of these activities, that is physical, psychological, sociocultural, environmental and politicoeconomic; and (4) a dependence/independence continuum.

The 12 activities of living are:
1 breathing
2 mobilizing
3 personal cleansing and dressing
4 maintaining a safe environment
5 eating and drinking
6 communicating
7 dying
8 eliminating
9 maintaining body temperature
10 expressing sexuality
11 working and playing
12 sleeping.

According to Roper and her co-workers (2000), by assessing each of these aspects it is possible to determine a person’s individual nursing and health care needs and in doing so determine priorities of care. For example, when assessing an adult with an enduring mental health problem such as chronic depression, eating and drinking may be the priority of care, whereas if caring for a very young child, maintaining a safe environment might be the most urgent concern.

To return for a moment to Fred, clearly the illustration presented is of just one aspect of his care needs related to the physical side of the ‘activity of breathing’. In order to deliver holistic care (i.e. making sure that all his care needs are met), each factor of each activity must be assessed and his level of independence or dependence determined. So, for example, Fred may also be very anxious about not being able to expectorate his sputum and may think that if he cannot cough it out he will die. This illustrates how the activities, in reality, often overlap. By providing this simple framework, however, Roper, Logan and Tierney help to direct our
thinking in a more logical, sequential way and if every aspect of each activity is covered when clients are assessed a clear picture of their individual needs should emerge without the omission of any important points.

Whilst some might argue that Roper, Logan and Tierney’s model is not appropriate in caring for clients with learning difficulties or mental health problems, it is in fact the most widely used framework in Europe regardless of setting. If utilized to its fullest extent, it can usefully direct learners in any field of health care. Therefore, the remainder of this text is structured around their 12 activities of living to help readers to relate the theory to everyday practice.

Each of the following 12 chapters offers: an introduction to the activity; common terminology related to that activity; points to consider when assessing the activity; followed by fundamental care skills related to that activity. Appendix I is a rapid reference section, which gives a detailed glossary to support the main text, normal values and other such useful information. Appendix II provides an opportunity for readers to record their achievements.

Finally, as a point of note, whilst acknowledging the variety of terms in use, as well as possible gender issues, for ease and continuity the term ‘client’ has been used throughout this text.