The Roper – Logan – Tierney Model also includes empathizing with the patient and helping him to adjust to his new environment, being sensitive to the patient’s feelings and emotions as it involves intruding upon his personal privacy. Some of the other skills used in this model are good communication and clear assessment and the skill to provide an environment that is conducive to better patient outcomes.
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The Florence Nightingale Model of Nursing:
Florence Nightingale (1820 – 1910) was born of rich parents in the city of Florence. She is the role model of the nursing fraternity all over the world. Her parents did not approve when Florence showed a great interest in becoming a nurse but never – the – less, she completed her training at Kaiserwerth in Germany in the year1851 and became a superintendent of a hospital in Harley Street (Florence Nightingale, 1853)
During the Crimean War, there was absolute lack of medical facilities and the wounded British soldiers were in a pitiable condition with hundreds of them dying from over crowding and unhygienic surroundings. The war minister, Sydney Herbert (1854) put Florence in charge of a group of nurses in a military hospital in Turkey. (November, 1854). Florence worked very hard both day and night together with her other nurses and greatly improved the bad conditions in the hospital by introducing a strict code of hygiene as she staunchly believed that infection spread spontaneously in dirty and poorly ventilated places. By following these principles she reduced the mortality rate considerably.
After the war Florence returned to England where she established “The Nightingale Training School” for nurses at St. Thomas Hospital in London. (1860). The nurses who trained here using the Florence Nightingale Model were sent to hospitals all over Britain. The primary aim of the Florence Nightingale Model is to ensure sanitation and good
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military health. Nightingale’s theories published in “Notes on nursing” (1860) have great influence and impact in planning established practices even today. Florence Nightingale’s farsighted reforms have influenced the nature of modern health care. (Florence Nightingale Museum Trust, 2003)
The Hildegard Peplau Model of Nursing: Inter personal relationships.
In 1947, Hildegard completed her M.A in Psychiatric Nursing from teacher’s college, Columbia, New York and an Ed. D in curriculum development from Columbia in 1953. During World War II, she was an active member in the Army Nurse Corps and worked in a neuro-psychiatric hospital in London. It was at Chestnut Lodge – the name given to the “psycho-analytical” hospital that Hildegard Peplau began her eventful career and learned so much there through reading, lectures and seminars.
The lectures of Eric Fromm greatly influenced Peplau who believed that it was possible to link psychoanalysis with sociology and political science. “It was his influence that steered Peplau towards social science rather than natural science (Callaway, 2002) She became seriously inclined to collapse the distance between patient and therapist. Peplau was also greatly influenced by Freud and the subject of interpersonal relationship between the patient and analyst became of great interest to her. She believed that the cure for a patient’s illness lay in the dynamics of patient – therapist relationships and therefore she slowly developed her own interpersonal theory of practice.
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Since she was dealing with shell shocked soldiers of the war, she implemented “formal and informal group therapy sessions with soldier casualties” (Callaway, 2002) By the later 1950’s psychoanalytic principles became the core curriculum study for the training of nurses. Peplau’s commitment to re- applying the psychoanalytic procedure of treatment, in the training of nurses cannot go unnoticed because she was emphatic that the principles of psychotherapy not only influenced but greatly complimented the procedure of nursing.
According to Peplau, "The idea of milieu as therapeutic environment, as it became popular during the 1950s and 1960s, gave recognition to the idea that the nurse-patient interactions within the milieu could be beneficial to patients”. [Peplau, 1989, p.78]. She also stated that, “It would seem that there are many theoretically orientated nurses who, with knowledge, skill and a computer, could now address this complex task, providing insight and direction." [Peplau, 1989, p.78].
The Best Model in Health Care:
In days gone by, the nursing fraternity and patient care was based only on the traditional model where the patient was looked upon as a machine having different parts. If any of these parts did not function properly or if it had broken down, it was repaired by
following a fixed path with knowledge as the base. This traditional model laid emphasis only on the physical aspect of the human being where the patient had to listen to the
7 doctor and follow his instructions only. The patient had no part to play what – so – ever in the outcome of his illness. This method however is rather out dated and with the advancement in both Science and technology linked with research by great scientists, better methods have revolutionized the field of medicine.
In lieu of this, the Florence Nightingale Method would lean a great deal towards the traditional method and hence is outdated for the fact that it doesn’t suit the changing times. On the other hand, Peplau’s Method with a psychoanalytical approach using interpersonal relationships does cater partially to modern health care and definitely has good scope for better patient outcomes than the traditional method.
When analyzing the Roper – Logan – Tierney Model we come to realize that the different aspects of the patient, as well as patient care, were taken into consideration. This model is best suited because it takes care of the different health care needs while utilizing a holistic approach. This method is patient – centered, in that it allows the patient to take an active part in the treatment of his own illness. Therefore I would choose this model for the treatment of my patient since it has much wider scope for better patient outcomes while building good relationships. Theorists:
Carper’s Theory:
According to theorist Carper, the nurse can come to understand how Carper (1978) identified knowing in nursing. For this, he used a prism through which he passed a shaft
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of light. Though it was a single shaft of light, the nurse could see a rainbow of colors separating out. Carper (1978) used this example to explain how she saw knowledge within nursing. In this way, Carper (1978) identified empiric, aesthetic, personal and ethical knowing. “None of these patterns are absolute” (Carper, 1978; Silva et al, 1995), and “none of these patterns were exhaustive of other patterns of knowing that are present or becoming visible to nurses as time moves on” (Carper, 1978; Silva et al, 1995).
Benner and Wrubel’s Theory:
Benner and Wrubel (1989) both describe “knowing how” as practical knowledge, and it is this knowledge of the nurse that is expressed via “…bodily intentionality and the habitual, skilled body” (Benner and Wrubel, 1989: 411). Such knowledge need not be in opposition to theoretical knowledge.
Benner’s (1984) theory is based on the “Novice to Expert” framework which describes that a gap exists between theory and practice when the nurse is a novice. As the nurse progresses through her learning and experience, she reduces this “gap” as she integrates her theory and practice. “At the expert level, where the practice and theory become a hybrid of practical and theoretical knowledge”… ((Benner, 1984; Pryjmachuk, 1996), the expert uses this integrated knowledge in different situations of health care.
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Organization of care:
The success of any Medical or Health care Centre depends solely on the organization of its care and other facilities offered. Therefore it is vital that the organization of care plays a major role in extending its services. In organizing nursing care, the patient is assured of being taken good care which will in turn result in a more better and speedy recovery.
Besides health care, one of the major public service areas is Social Care where the patient depends on a social worker or other social help groups for support either financially or otherwise. Currently, modernizing Social services has become a national priority and many organizations have come forward to lend support to the public by helping them to achieve the minimum conditions for living in dignity. For example “Care International UK and DFID Programs help the poor and marginalized people to realize their rights, responsibilities and aspirations by supporting their efforts and encouraging them to take control of their lives. (Care International, March 2006)
The UK forum for Hospice and Palliative Care is a network of both individuals and organizations based in UK, who work in tandem with each other to develop hospice and palliative care around the world where the resource settings are poor. In addition they develop and promote the sharing of information and experience and influence Government and policy makers to include hospice and palliative care in their health policies especially in resource poor countries. (UK Forum for Hospice and Palliative Care Worldwide)
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Skill Mix:
Skill mix is basically the amount of knowledge and skill an individual or health care team employs in their day to day work in order to maximize the effectiveness and efficiency in health care. It also refers to the different levels of expertise needed to manage the care of patients. Determining staff levels, workloads and dependency of patients have significant implications which all go to determine the numbers and skill mix of nurses.
The Department of Health has introduced a comprehensive review of skill mix and staffing methodologies through the Nursing Quality Research Program to be utilized in general nursing care. The report on this research from the Nuffield institute at the University of Leeds gives us a comprehensive understanding on “Skill Mix Tools” and “Methodologies” in addition to providing valuable information on the advantages and disadvantages of each of them while indicating where each of them would be more useful in their daily practice. It gives a detailed description and step by step instructions on how to use them. (Department of Health Website, UK, 17th January 2003)
Mounting evidence has proved that higher the number of qualified nurses, the better is the patient outcomes. But problems such as ward staffing, changing patterns in health care delivery and efficiency and effectiveness of staff in health care are issues that constantly keep cropping up. The four key elements that are needed to determine establishment and skill mix are – Competency, Dependency which includes workload, volume of patients and length of stay.
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Case Study using the Roper Logan Model:
Aspect of knowledge – Hygiene
Respiratory Ward-
Mr. Fletcher a man in his late forties visited the hospital complaining of a stuffy chest and incessant coughing. The nurse on duty welcomed him and reassured him that everything would be alright. She then asked him some questions about his general health and habits and gave him ample space to feel relaxed and explain himself. He was them ushered in to see the Physician who showed genuine concern for Mr. Fletcher’s condition. He then gave him a short physical examination using sterilized instruments and gloves.
The physician asked Mr. Fletcher to explain the nature of his job. He was told that he was working in a foundry for the last 15 years. He also explained that he was constantly exposed to dust and smoke for the whole time he was in the foundry.
The doctor told him that his health complaint was due to the nature of his work as he was exposed to so much of dust and smoke. The physician explained that his lungs were coated with so much of dust and smoke which was making it difficult for him to breathe easily. The physician then advised Mr. Fletcher that he would have to get admitted in order to get rid of his illness and he asked him for a suitable time.
Mr. Fletcher felt at ease with the doctor as well as the nurse because they showed genuine interest in his condition. He showed interest in wanting to get better soon and so decided that he would admit himself the next day.
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The next day when Mr. Fletcher got admitted, the nurse in charge took trouble in explaining that personal hygiene was of utmost importance. She advised him on respiratory hygiene by telling him he had to cover his mouth and nose while coughing or sneezing. She also asked him to keep some tissues close at hand in case he had to use them. He was advised to throw the used tissues into a closed waste receptacle. In case he came into contact with respiratory secretions or other contaminated articles he was supposed to wash his hands with an antiseptic or an alcohol based hand rub. The nurse showed Mr. Fletcher where the tissues and hand wash were kept.
The doctor sat with Mr. Fletcher and discussed on the action plan that would best suit him. They went through the procedures once again till Mr. Fletcher was satisfied and happy at the course of action. Medication was administered by the nurse conscientiously from time to time and she and the doctor maintained a good rapport with Mr. Fletcher.
After about a week in the hospital Mr. Fletcher was breathing easily and freely. He was discharged soon after but advised to continue his personal hygiene and his medication. He was asked to visit the doctor for a follow – up after two weeks.
When Mr. Fletcher visited the hospital after two weeks he was all praise for both the doctor as well as the nurse in charge of the Respiratory ward and so thanked them profusely.
In this scenario, the Roper – Logan – Tierney Model was put into action and the outcome was the patient was thoroughly satisfied with his experience at the hospital which in turn made him get better faster.
References:
BBC History – Florence Nightingale (1820 – 1910)
NMC Internet
Advanced Nursing Practice
Applying the Roper – Logan – Tierney Model in nursing
www.elsevier.com/wps/product/cws_home/693517
Welcome to Nurse Minerva
www.nurseminerva.co.uk/catheter.htm
The Florence Nightingale Museum Trust
Critically evaluate the use made of Philosophy, knowledge and theory…..
Benner, P. (1984). From novice to expert:
Uncovering the knowledge embedded in clinical practice.
Boston. MA: Addison-Wesley.
Carper, B.A. (1978). Fundamental patterns of knowing in nursing.
Advances in Nursing Science, 1(1), 13-23.
Care International UK
International
Skill Mix for matrons and ward managers/ PL CNO (2003) 1
.
Balancing the Shift –Exploring key issues
CDC – Influenza/ Flu – Respiratory Hygiene