The Roper, Logan and Tierney (1996) model: perceptions and operationalization of the model in psychiatric nursing within a health board in Ireland

'Who's actually gonna read this?' An evaluation of staff experiences of the value of information contained in written care plans in supporting care in three different dementia care settings

WHAT IS KNOWN ON THE SUBJECT?: A written plan is designed to improve communication and co-ordinate care between mental health inpatient wards and community settings. Reports of care plan quality issues and staff and service user dissatisfaction with healthcare bureaucracy have focused on working age mental health or general hospital settings. Little is known about mental health staff perspectives on the value of written care plans in supporting dementia care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Competing demands on staff time and resources to meet administrative standards for care plans caused a tension with their own professional priorities for supporting care. Mental health staff face difficulties using electronic records alongside other systems of information sharing. Further exploration is needed of the gap between frontline staff values and those of the local organization and managers when supporting good dementia care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Frontline staff should be involved in designing new information systems including care plans. Care plan documentation needs to be refocused to ensure it is effective in enabling staff to communicate amongst themselves and with others to support people with dementia. Practice-based mentors could be deployed to strengthen good practice in effective information sharing.

ABSTRACT

Background Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. Aim To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service (NHS) provider Trust in England. Method Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. Findings Five themes were identified and are explored in detail below: (1) Repetition; (2) the impact of electronic records on practice; (3) ambivalence about the value of paperwork; (4) time conflicts; and (5) alternative sources of information to plan care. Discussion Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. Implications for practice Frontline staff should be involved in designing new information systems including care plans.

Reviewing the evidence on nursing record systems

The aim of this article is to examine the relationship between nursing practice and the recording of practice. We outline the main findings of a Cochrane systematic review on nursing records, discussing the indications from the included studies that compared computerized nursing care planning with paper-based systems. Qualitative research on nursing records systems, and other survey evidence, is collated to answer questions on the format of the record (structured versus free text, for what type of practice), occasions when information exchange about nursing care may not and should not be recorded formally, and the effective organization of the nursing record. We conclude that more research is required to answer these questions, as it seems that computerization does not always bring the expected benefits, and outcomes for patient care are not clear.

Effectiveness of home monitoring according to the Model of Living in hip replacement surgery patients

AIMS AND OBJECTIVES

To evaluate the effectiveness of home monitoring according to the Model of Living in hip replacement surgery patients.

BACKGROUND

Hip replacement surgery is important for increasing the quality of life of patients. After these operations, patients may encounter many problems having an impact on their activities of daily living.

DESIGN

Quasi-experimental.

METHODS

Sixty patients were included in the study: 30 in the experimental group and 30 in the control group. Patients in the control group received the existing care provided in the hospital. In addition to existing care, patients in the experimental group received training and counselling according to the Model of Living from the time of admission to the clinic. After discharge, home monitoring was performed in the 1st and 6th weeks for control group patients and in the 1st, 3rd and 6th weeks for experimental group patients. Statistical analysis was carried out using percentage calculations, mean, median, chi-square test, Fisher's exact test, likelihood ratio test, Mann-Whitney U-test, Kruskal-Wallis test, anova for repeated measures, independent-sample t-test, Friedman test, McNemar test and McNemar-Bowker tests.

RESULTS

It was found that the experimental group patients' knowledge scores increased, they were more independent in performing activities of daily living, and they encountered less problems in the 1st and 6th week after discharge.

CONCLUSION

As a result, it can be claimed that by means of providing training, counselling and home monitoring hip replacement surgery patients according to the Model of Living, the level of knowledge of patients on activities of daily living increased, they were more independent in daily living activities, and they experienced less problems.

RELEVANCE TO CLINICAL PRACTICE

The use of the Model of Living in the home monitoring of patients who have undergone hip replacement surgery could assist in focusing on the problems most frequently experienced by patients in postoperative care and achieving effective solutions.

Care planning in the emergency department

There are many demands placed on staff working in emergency departments such as the currently witnessed overcrowding, bed shortages and long waiting times for patients. Despite these demands nursing care needs to be carefully assessed, planned and documented. This study aimed to examine attitudes of staff towards the use of a nursing care plan in the emergency department. The sample comprised the total population (n=38) of all nursing staff working in an emergency department at one regional general hospital in the Republic of Ireland. The method adopted was a survey approach which employed the use of standardised questionnaires comprising both open and closed questioning styles. Raw statistical data were analysed using SPSS for Windows while the qualitative data arising from the open-ended questions were manually analysed for themes. The data obtained in this study identified that care plans were valued by respondents, stating that they contribute to holism, increased nurse/patient contact time and better communication. The findings also identified that there is a need for continuing education, further research and a need to address issues in relation to specific patient groups, including paediatrics, minor injuries, mental health and the elderly attending the emergency department.

A critical review of appropriate conceptual models for use by coronary care nurses

BACKGROUND

There is little evidence of the extent of conceptual model use within cardiovascular nursing. Concern exists within nursing that nursing theory and conceptual model use within practice is less than optimal. It is further suggested that there is little evidence of nursing theory occupying its true position as the central tenet of nursing practice and cardiovascular nurses have been challenged to reconsider this aspect of practice.

AIM

The aim of this review is to explore the effectiveness of conceptual models used within cardiovascular nursing to further explore their potential benefit.

METHODS

Using key terms, a search was conducted using electronic databases CINAHL and PUBMED; yielding seven papers that fulfilled selection criteria.

FINDINGS

Few papers related to research studies in the area. However, of those identified significant examination and testing of concepts emerged within the studies. Rather than merely using concepts as an organizing framework or a component of the study, theories alluded to were scrutinized and consistently applied. Although studies identified mostly referred to specific testing and examination of aspects of conceptual models, the notion of self-care and support for clients emerges as a strong theme within the review. The relationship between nurse and client seemed to be pivotal in any noted improvements.

CONCLUSIONS

The findings have limited application to practice. In the absence of large-scale longitudinal studies, only selected aspects of conceptual models or theory were scrutinized. Further research is required in this area to identify conceptual models of nursing that are most appropriate for cardiovascular nursing care.

Using the Roper, Logan and Tierney model in care of people with COPD

AIM

To determine whether the Roper, Logan and Tierney Model of nursing care affects the outcomes of patients with chronic obstructive pulmonary disease.

BACKGROUND

Chronic obstructive pulmonary disease is a leading chronic health problem throughout the world. Although there are numerous studies on patients with chronic obstructive pulmonary disease, no studies have been found regarding patient care with chronic obstructive pulmonary disease investigated from the Roper, Logan and Tierney Model perspective.

METHODS

The study design was an experimental style. The sample consisted of 60 subjects with a diagnosis of chronic obstructive pulmonary disease who were hospitalized in a university hospital in Erzurum, Turkey, in 2001 and randomly selected into control and experimental groups. On admission, the researcher completed a nursing diagnosis form for chronic obstructive pulmonary disease for each patient, consisting of demographic characteristics and an assessment nursing diagnosis for each of the patients. Control group patients were treated by routine nursing care while the experimental group patients were treated by nursing care according to the Roper, Logan and Tierney Model. Upon discharge, nursing diagnoses were assessed again in both control and experimental groups. Results. Although there was no statistically significant decrease in most nursing diagnoses in the control group, there was a statistically significant decrease in nursing diagnoses in favour of the experimental group.

CONCLUSION

This study demonstrated that there were improvements in patient's outcomes in the concept of holistic and individualized nursing care of patients with chronic obstructive pulmonary disease according to the Roper, Logan and Tierney model.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study have practical importance for nursing practise. Using the Roper, Logan and Tierney Model in care of patients with chronic obstructive pulmonary disease may serve as a guide for nurses working with chronic obstructive pulmonary disease patients to participate patient and her/his family to patient care and to facilitate the effectiveness of patient care.

A critical analysis of the potential contribution of Orem's (2001) self-care deficit nursing theory to contemporary coronary care nursing practice

BACKGROUND

Over the last three decades, nurse theorists have strongly advocated the use of conceptual models of nursing to guide nursing practice. Within coronary care units, conceptual model-based care has had inconsistent application and is currently challenged by contemporary approaches such as pathways of care.

AIMS

This paper aims to critically analyze the use of Orem's self-care deficit nursing theory as a modus operandi to effectively meet the needs of hospitalized patients in coronary care.

RESULTS

Although complex both in the language and construction, the self-care model , provides a comprehensive and holistic approach to the care of people in coronary care.

CONCLUSIONS

This paper highlights the potential contribution the application of the self-care deficit nursing theory to the coronary care setting from a philosophical and practical perspective. Orem's conceptual model of nursing and current practice in coronary care units share certain similarities that render a useful model for use in practice. However, while it is recommended for consideration for use in both practice and educational settings, further empirical work is required in the area, together with realistic and practical application of the theory to practice in a way that embraces contemporary notions.

Conceptual models used by nurses working in coronary care units--a discussion paper

In the UK, Europe and the USA conceptual models of nursing are features of many undergraduate nursing curricula [Alligood MR. The nature of knowledge needed for nursing practice. In Alligood MR, Marriner-Tomey A, editors. Nursing theory utilisation and application. London: Mosby, 2002, Tierney AJ. Nursing models extant or extinct? J Adv Nurs 1998;8(1):77-85] and commonly used in practice. However, UK nurses in practice continue to be dissatisfied with conceptual model use [Griffiths P. An investigation into the description of patients' problems by nurses using two different needs-based nursing models. J Adv Nurs 1998;28(5):969-977, Mason C. Guide to practice or 'load of rubbish'? The influence of care plans on nursing practice in five clinical areas in Northern Ireland. J Adv Nurs 1999;29(2):380-387, Murphy K, Cooney A, Casey D, Connor M, O'Connor J., Dineen B. The Roper, Logan and Tierney Model: perceptions and operationalization of the model in psychiatric nursing within one health board in Ireland. J Adv Nurs 2000;31(6):1333-1341]. An association with increased paperwork and documentation together with a belief that these abstract concepts do not quite fit with the practice setting has resulted in a generalised apathy towards their use in some areas [Timmins F. Critical care nursing in the 21st Century. Intensive Crit Care Nurs 2002;18:118-127]. In an era of concerns about both cost and quality, together with an increased impetus towards multi-professional working patterns and role expansion, alternative models of care, such as critical pathways and care pathways are gaining increased favour in the clinical setting [Johnson S, editor. Pathways of care. Oxford; Blackwell Science 1997]. The aim of this paper is to consider whether or not the traditional conceptual models of nursing are apt for today's practicing coronary care nurse. Specific questions to be addressed are: what is the research evidence that informs conceptual model use in coronary care and what are the conceptual models that commonly inform contemporary practice in coronary care nursing? Suggested ways forward for conceptual model use within nursing are also proposed.

Partnership in coping: an Australian system of mental health nursing

The paper identifies shortcomings of approaches used in organizing and delivering mental health nursing. It provides a rationale for the development of a new system of mental health nursing namely the Partnership in Coping system (PinC). This system has been developed by service users, clinical mental health nurses and an academic mental health nurse. Currently, it is undergoing trials in Western Australia. The PinC focuses on the strengths of clients. It uses the positive aspects of mental health nursing namely its holistic perspective, the length and nature of the informal contacts, the 'ordinariness' of relationships with clients and the nurse's knowledge of the clients' social and physical environments. It is a versatile system that can also be used across different mental health settings (community and inpatient facilities). The paper describes the philosophy behind the system, the concept of coping, the nature of the partnership between the client and nurse and their respective roles.

Using the Roper-Logan-Tierney model in neonatal transport

In recent years approaches to nursing practice have changed. Nursing theorists have advocated the need for nursing practice to be carried out using a systematic rather than an intuitive approach. A process of nursing has been developed as a method of organizing and delivering nursing care. This change in nursing practice has resulted in the need to establish a knowledge base that relates specifically to nursing. Conceptual models of nursing, advocated by nursing theorists, have come into use in Ireland, the UK and the USA. These models aim to promote greater understanding of people and their nursing needs. They advocate a certain approach to nursing and attempt to define nursing as a role independent from other health care roles. The need to develop a knowledge base specific to nursing remains a central tenet of the profession (Aggleton and Chalmers, 2000). Nursing models serve to provide this knowledge base through the description of the nature of people, health, environment and nursing. The aim of this article is to explore the use of the Roper-Logan-Tierney (RLT) nursing model in a neonatal transport setting. The first section provides an overview of the model. The second section describes the background information on a selected patient, followed by a detailed assessment of this patient using the activities of living. The final section evaluates the use of the model in this clinical situation with reference to literature on the topic.

The meaning of models of nursing to practising nurses

BACKGROUND

It is contended that models of nursing have lost the momentum and challenge that they promised the profession. Their use, value and purpose have been seriously questioned and new perspectives on their use and implementation in practice, education and research are required. In addition, limited evidence exists on the implementation of models into clinical areas.

AIM

To explore the meaning of models of nursing to practising nurses.

METHODS

Serial interviews with qualified nurses who were undertaking an educational programme or module that explored and examined models of nursing.

FINDINGS

The outcome reveals that the use of the terms, models of nursing or nursing model, are limited and confusing as the terms can encompass a range of meanings. It is suggested that a three-model typology exists that clarifies more fully the present position of nursing models. The three models are Theoretical Model, Mental Model and Surrogate Model.

LIMITATIONS

The focus on data collection through serial interviews with qualified practitioners could have been broadened to include a range of data sources such as teachers and clinical areas, which could have enriched the phenomenon of models of nursing.

CONCLUSIONS

There is a greater need to understand nursing models within the framework of the three-model typology and to reconsider their introduction and use in this context.

Judgement days: developing an evaluation for an innovative nursing model

This paper reports on the process and outcomes of the evaluation of an innovative nursing model (the Tidal Model). In relation to process, the study has been used to refine the methodology in terms of defining important variables to take as outcome measures to be analysed both descriptively and inferentially. In relation to outcomes, the pre-post-test design has generated significant findings in relation to improved patient care.

The tidal model: developing a person-centered approach to psychiatric and mental health nursing

TOPIC

Overview of the theoretical and practical basis of a new model of psychiatric and mental health nursing practice.

PURPOSE

To illustrate the history of the development of the model and some of the processes that aim to re-empower the patient and develop genuinely collaborative approaches to care.

SOURCES

Literature review, author's research, and related clinical experience.

CONCLUSIONS

The Tidal Model provides a practice framework for the exploration of the patient's need for nursing and the provision of individually tailored care.

The Tidal Model: developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing

Nursing theories and nursing models have a low profile within psychiatric and mental health nursing in the United Kingdom. This paper describes the philosophical and theoretical background of the Tidal Model, which emerged from a 5-year study of the 'need for psychiatric nursing'. The Tidal Model extends and develops some of the traditional assumptions concerning the centrality of interpersonal relations within nursing practice. The model also integrates discrete processes for re-empowering the person who is disempowered by mental distress or psychiatric services or both. The paper reports briefly on the ongoing evaluation of the model in practice.