Nursing processes are bettered through the use of assessments that are well-structured and guided by a model of care. Thus, there are several models of care utilized in the nursing profession. Nursing models are comprised of nursing concepts and theories. A nursing theory is a principle used to augment nursing practice. Through the application of nursing theories, nurses can plan, implement, and assess the care that they provide to their patients, through the provision of a framework within which they can operate.The RLT model makes use of nursing practices that are geared towards assisting patients regardless of their medical or psychiatric diagnosis. It focuses on the facilitation of their daily living activity management, such that they can return to an optimal state with regards to health (Roper, Logan, and Tierney, 1985). In this paper, the use of the RLT model will be demonstrated for the treatment of the patient MJ, whose name has been altered for the sake of patient confidentiality.
Roper Logan Tierney Model
Background
Until relatively recent times, the practice and science of nursing were derived from biological, medical, and social science theories (Marudhar & Bashir, 2019). However, as the number of nurses increased, so did the number of nursing theorists. Thus, from the 1950s, several nursing practice theories emerged that could be used to develop knowledge and higher-quality practice (Marudhar & Bashir, 2019). Models grew from this nursing theoretical basis. They existed as a way to give the abstract themes of nursing theories a practical form.
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There are a few different types of nursing theories on which models are based. First are interaction theories, which revolve around the type of relationship that is created between the nurse and the patient. Another type is outcome theories, which focuses on the nurse’s role as the one creating change or adaptation in lifestyle for a patient with a medical condition. The third type of nursing theory is humanistic theories, which focus on patients’ self-actualization and creating person-centered therapy. The final type of theory, and the one most relevant to this model application, is needs theories (Marudhar & Bashir, 2019). Needs theories focus on providing the best assistance for patients to meet their daily requirements, both those that are mental and those that are physical.
RLT Contents
There are a variety of means through which a nurse can achieve the goal of assisting their patients with meeting daily needs. In Roper Logan Tierney model, the goal is to organize the healthcare and nursing practices that occur around the patient's daily life. Thus, the model requires nurses to gather and understand information pertinent to the patient and then plan their care intending to allow their patients to achieve autonomy. The overall goal of the RLT model is to have a patient attain independence at every level of their care.
RLT has been referred to as a nursing practice-centered model based strongly on accessibility and realism. This model is simple because it uses the basic nursing process as its guide: diagnosis, assessment, evaluation, intervention, and planning. Using this basic 5 step process, RLT allows the nurse to conduct a holistic patient assessment and serves as the basis of the care plan that they will follow (Williams, 2015). RLT has been popularized because it is applicable both within the academic and the clinical setting. In the clinical nursing setting, RLT is applied by addressing questions about functional deficits that are specific to the patient receiving nursing care (Marudhar & Bashir, 2019). In the academic setting, RLT is used to help nurses develop hypotheses about care outcomes within a nursing framework (Williams, 2015).
Within the practical clinical setting, RLT is applied by highlighting 12 main daily activities. Addressing these activities assists in the identification of the functional deficits which the nurse can work to rectify. These 12 activities include breathing, eating and drinking, communication, eliminating, dressing, cleaning, controlling body temperature, work, play, expressing sexuality, and dying (Marudhar & Bashir, 2019). This list represents the average persons’ daily tasks.
These 12 activities are one of 5 main components that comprise the RLT model. The other four components are the dependence continuum, lifespan, individualized nursing, and factors influencing living (Williams, 2015). By taking heed of all five components, the nurse can fill in any gaps that a focus on only the 12 activities would create (Williams, 2015). In this way, holistic healthcare can be provided to the patient. The dependence continuum refers to the patient's level of performance throughout the application of the RLT model (Williams, 2015). By using this continuum, the nurse can tell whether the patient is moving towards or away from independence. Furthermore, the continuum acts as a means of evaluating the patient's progress, as a patient can perform well to begin to backslide (Williams, 2015). The lifespan component keeps the patient's lifespan in mind, as that can have an effect on how capable they are of true independence, and inform on the realistic nature of the goals that have been set for independence before the initiation of the nursing care.
The ‘factors influencing living’ component of the RLT requires a nurse to take into account any sociocultural, biological, psychological, or environmental factors that can affect the patient's journey to independence in their treatment (Williams, 2015). For example, patients suffering from social isolation from their support system will need to learn tools that will allow them to operate fully on their own, both during their hospital stay and after discharge. On the other hand, a patient with a strong support system would need the involvement of their support system in the learning process, so that all parties are fully aware of their needs both within the hospital and for life after discharge (Williams, 2015). The final component, individualized nursing care, refers to ensuring, after accounting for the other components, that the treatment plan created is catering specifically to the patient’s needs, rather than generally perceived needs
Exemplar
The patient in this case is named MJ and is a 25-year-old single woman. She has one child aged ten, whom she gave out for adoption immediately after birth. MJ is a working student. With regard to work, she is employed at a fast-food canteen part-time. During the rest of her time, she is a college student pursuing a degree in marketing. MJ complained of sharp pain in the umbilicus region of her body, which intensified in the lower abdominal quadrant on her right side.
After a physical examination, it was noted that she had developed abdominal guarding, and that the region was tender. The surgical team admitted her after this examination. Additional prevailing symptoms in the patient included fever, nausea, constipation, and appetite loss. As she had a past medical history of urinary tract infection, urine analysis was performed on the patient to ensure that the symptoms were not the product of a reoccurrence of this infection. Blood samples were also taken to assess any raised white blood cell count. M.J had no previous history of abdominal pain.
A few factors were noted to affect her condition. Whenever she was lying down with her knees pulled up, the patient reported feelings of relief. MJ also denied any alcohol consumption, with no types of medication whatsoever, and did not present any urinary symptoms. Upon observation, MJ seemed to be tired and anxious, which was especially a result of the constant pain.
As the assessment proceeded, a therapeutic relationship was deliberately created and fostered with the patient. As a result, MJ opened up and revealed that she had a poor diet, as she often did not have enough time to prepare balanced meals. Thus, her diet generally consisted of unhealthy snacks. Furthermore, she did not generally consume any vegetables or fruits. As a result of her poor diet and largely sedentary lifestyle, MJ had accumulated much weight over the years. She reported that she did not engage in any type of regular exercise.
Diagnosis
The appendix is the short, thin blind-ended tube that appears at the end of the caecum. Appendicitis is a condition that is created when the appendix is filled with fecal waste as well as other waste materials (De Moura et al., 2015). Often when the caecum is obstructed, the blockage can be the result, causing inflammation of the appendix. It is a common cause of appendicitis, which was the condition in MJ’s case.
Although appendicitis is one an often-performed surgery across the globe, its specific causes have not been completely clearly elucidated. While many possible reasons exist, and it is common enough for each individual to have an 8% chance of getting the condition during their lifespan, its mechanism of action is still poorly understood in the medical field (Bhangu, Søreide, Di Saverio, Assarsson, & Drake, 2015). One commonly cited reason is that the main acknowledged mechanism of the condition is the obstruction of the appendix, which has been cited above. This obstruction could be the result of impacted stool, a caecal tumor, an appendiceal tumor, a faecolith, or lymphoid hyperplasia. However, the fact remains that a significant proportion of appendicitis cases do not feature a luminal obstruction. There are several cases where the development of appendicitis was associated with an infectious agent. In other cases, environmental influences are the cause, as a certain area has a higher prevalence of the condition than average. Overall, however, despite the poor understanding of the exact causes, the treatment for appendicitis is one that is generally applied – the excision of the appendix.
Application of the RLT model
This application begins with the nurse’s use of theoretical knowledge and awareness to dislodge any fears that the patient may have (De Moura et al., 2015). After the preliminary concerns are addressed, an outline was received for the patient showing her sleeping pattern and discussing her mobility, including analgesics prescribed for relieving pain, including tramadol and paracetamol. Her post-operational physiotherapy sessions were outlined in the chest exercises, which were to be discussed at length with the patient to ensure that she was fully informed. Furthermore, an elaboration on wound care and catheter removal was included in the outline so that this important part of the post-operative care was communicated to the patient. The handover was assessed so that the priority areas requiring specific communication skills were identified, and necessary information could be gathered for the beginning of the care process (Turan & Sandir, 2019).
Breathing
In this case, the application of the RLT model identified breathing as a possible gap in the function that could occur during MJ's healing process. Thus, several activities were undertaken to ensure that this would not be an issue that would affect the patient's independence. After assessing M.J, it was confirmed that she was tired even after a full night's sleep. Listening to her speak, it was notable that she had a quiet speech with irregular chest movements. After ensuring that MJ had no nail polish on that could affect the oximetry machine's readings, she was assessed and found to have her oxygen levels at 94%, which is within the normal range. To prevent any development of chest infections, according to the RLT nursing plan devised, a physiotherapist worked with M.J to teach deep breathing exercises. Communication with the patient was applied when giving M.J care in the process of inspecting her sputum's color to assess any infections, inform the patient, and address concerns and questions.
Mobility
Another area that had been identified as a potential functional deficit post-operation was mobility. However, MJ had no real barriers to mobility upon assessment. Further, she showed improvement in her fatigue and breathing levels. The surgical team had prescribed the TED socks, which the patient refused to wear. This was an incident where the RLT model came into play to ensure patient adaptation is patient education. Applying communication as a therapeutic intervention, a rapport was built, and MJ revealed that she was afraid of dying in which she explained she was the only hope in her family. Remembering her parents, she discovered she needed to heal faster and resume her studies in which she accepted to use the anti-embolism stockings.
Personal Cleansing and Dressing
M.J's wound was cleaned using the aseptic technique after assessment in which there was an application of a new dressing. She was then assisted with the personal cleaning needs in which she confirmed some improvements, thus an indication of improvement of the body image while avoiding the infection period increase.
Conclusion
In conclusion, the application of the RLT model in post-operative care is a great process for teaching nursing practice, and improving the quality of care that is provided to the patient. Furthermore, it creates awareness of the nursing process for students, offering them an opportunity to gather the necessary information in a useful manner. One of the major benefits of applying the RLT model is that it provides the knowledge necessary for dislodging any fears in patients while giving them assurance in their healing processes. It also assists in anticipating and treating inpatient needs in a way that is enabling rather than disabling. Therefore, RLT is an important model in offering a framework through which care can be offered to the patient.
References
Bhangu, A., Søreide, K., Di Saverio, S., Assarsson, J. H., & Drake, F. T. (2015). Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet, 386(10000), 1278–1287. doi:10.1016/s0140-6736(15)00275-5
de Moura, G. N., do Nascimento, J. C., de Lima, M. A., Frota, N. M., Cristino, V. M., & Caetano, J. A. (2015). Activities of living of disabled people according to the Roper-Logan-Tierney model of nursing. Rev Rene 16 (3).
Marudhar M., & Bashir J. (2019). Nursing theories. Presentation. https://www.researchgate.net/publication/333022822_nursing_theories
Roper, N., Logan, W. W., & Tierney, A. J. (1985). Model of nursing: explanatory booklet. https://www.lenus.ie/bitstream/handle/10147/333669/modelofnursing.pdf?sequence=1&isAllowed=y
Turan, N., & Sendir, M. (2019). Defining Care Needs for Inpatients in the Orthopaedics and Traumatology Clinic. International Journal of Caring Sciences 12 (2).
Williams, B. C. (2015). The Roper-Logan-Tierney model of nursing. Nursing 45 (3), 24–26. doi:10.1097/01.nurse.0000460730.79859.d4
