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10203 Integrated Nursing Concepts 1- TUTORING BY REGISTERED NURSE

03 Jul 2021 249 Views Sarah

10203 Integrated Nursing Concepts 1

Assessment item 2: Essentials of care using evidence – reflective piece


The paper is the critical analysis and reflection over my learning in this semester associated with the assessment and communication of the activities of daily living (ADL).  The Roper-Logan-Tierney Model for nursing is the key assessment conducted in this niche and has been reflected in this paper. Through the use of the Borton’s model of reflection, this reflective paper is being presented and demonstrated. 

The good patient experience is clinically and practically underpinned through the count of necessary needs that reflect over the core concepts of the patient care. These needs consist of meeting the patient needs in terms of the continence care, personal hygiene, nutrition, respect, dignity, confidentiality, personal hygiene, and prevention as well as management of the pain (Peate, 2019). This is defined as the “essentials of care” under one umbrella term.  Thus, the nurse plays the key role in assuring that the nurse works with the multidisciplinary healthcare team members to assure that all the essential needs of the patient are met and fully supported without any delay (Miller & Nambiar-Greenwood, 2019).   


The ADL is clinically used as the indicator of the functional status of the person. When the person is incapable to perform ADL, it leads to dependence over other individuals or/and the mechanical devices. This results in unsafe conditions and highly poor quality of life (Peate, 2019). For nurses, it is necessary to measure the patient’s ADL as the predictor of admission towards the nursing homes, using paid home care, need for the alternative living arrangements, and hospitalization (Holland & Jenkins, 2019).

This semester taught me that the nurses are usually the first healthcare professional who notes down if the patient is declining in his/her functionality during hospitalization. Thus, the routine screening of the ADLs is most essential and the nursing assessment of the ADL's has to be performed on every patient being hospitalized (Peate, 2019). It is necessary because hospitalization for chronic or acute illness can influence the ability of the person in meeting the personal goals and be able to sustain the independent living (Peate, 2019). With progression in the chronic illnesses with time, it leads to the significant physical decline that leads to loss of capability in performing ADL and this further contributes to psychological stress and disorder development (Miller & Nambiar-Greenwood, 2019).

I have acknowledged through this semester that there are multiple factors that impact or influence ADLs. There are five factors that make the RLT model of nursing for independence continuum management and make the model holistic in approach (Holland & Jenkins, 2019). These factors are utilized for determining the relative independence of person and the needs to restore their independence for every other ADL. First, the biological factors impact the complete health and individual’s scope of physiology and anatomy to be considered (Peate, 2019). For an instance, the chronic illnesses like hypertension makes huge changes in person’s nutritional activities as compared to people without hypertension. This needs immediate consideration. Secondly, I have learned that psychological factors include spiritual beliefs, cognition, capability to understand and emotions as whole. For instance, psychotic patient have altered thoughts that influence his/her communication independence (Williams, 2017). Third, the socio-cultural factors of the person define how an individual perceives the health and carries the activities of daily living. For instance, a person being cared in residential care is assumed to have declined cognition and infirmity, even if it is not influencing the nursing care delivery. Forth factor category is of environment (Miller & Nambiar-Greenwood, 2019). The RLT model states that both environment and ADLs are interrelated. Impact on one impacts the other. For example, presence of damp affects person’s breathing independence and soiled dressing with hazardous fluids impacts the nature where it is disposed. Last, I have learned that politico-economic factors like government funds and access to benefits are major barriers to better healthcare and independence (Holland & Jenkins, 2019).

So What?

I have acknowledged the basic thing. From basic ADLs like feeding, ambulating, dressing, continence, toileting and personal hygiene to instrumental ADLs like managing finances, transportation and shopping, meal preparation, managing medications, managing communication with others  (Peate, 2019), and housecleaning and home maintenance, nurses play their role in supporting the patient. Furthermore, this semester presented me with clear picture of the role of nurse in the process of accessing and communicating the essentials of care for the future practice (Hickish & Roberts, 2019). I have learned that the Roper-Logan-Tierney Model is entirely for Nursing. This is a theoretical nursing care practice that will be sustaining for decades in the future. The activities of daily living is always affected when a person is ill or is under serious health issue or hospitalized or in the recovery process. Me as a nurse is highly responsible for assessing patient’s essentials of care required or changes to assure best patient care (Australian Nursing and Midwifery Council, 2016). The nurse has to use this assessment method to assess how the patient life has altered because of illness, admission to the hospital or injury instead of the way of planning to enhance the independence and better quality of life. This will define what living actually means (Peate, 2019). The nurse will consistently categorize the discoveries into the patient’s activities of living via full assessment. This will lead to better interventions supporting patient independence in the areas that are complex for the patient to have its addressing alone (Williams, 2017). The nurse in the future has to define and follow the goal of assessment and the interventions for promoting maximum patient independence. I have to be focused on keeping complete record of patient’s essential of care and keep updates from time-to-time to assure patient is supported at the best and is reviewed on defined intervals. This will help the nurse to be efficient in supporting the patient and family (Williams, 2015). The nurse has to play the crucial role in determining the interventions that can result in increased independence and the determination of ongoing support required to offset the dependency that persists (Hickish & Roberts, 2019). I have also acknowledged that in the future the activities of daily living or essentials of care should not be utilized as a checklist as it is used currently. It should be a cognitive approach to be applied in the core nursing approach and better organisation of care. This will help the nurses to have in-depth understanding of this model and wider application (Australian Nursing and Midwifery Council, 2016).

Now What?

I have understood and decided to be more knowledgeable and efficient in the use of three concepts during ADL procedures that are dignity, comfort and safety. In my future practice, I will focus on maintain patient’s dignity at all levels. If patient is no longer able to bathe or self-groom, I will reassure and behave in a matter-of-fact not patronizing the patient (Williams, 2015). I will interact during all sessions to make patient feel involved and not being cared like an infant. To assure modesty and warmth, I will keep my patient’s parts being covered as soon as bathed or cleaned to avoid any undignified act (Peate, 2019).

For patient’s comfort, I am determined to check everything twice before using with the patient or for the patient like checking temperature of bathing water and sharpness of razor (Miller & Nambiar-Greenwood, 2019). To assure patient’s comfort, I need to inform and take consent before every task, communicate in soothing and conversational voice, allow patient to assist or involve as much possible, using products preferred by patient, doing little extra and making patient feel comfortable in all situations. I have also decided to enhance my communication skills to an advanced level by attending workshops and learning forums (Australian Nursing and Midwifery Council, 2016).

For patient’s safety, I think I am little unsure of my capabilities as safety is a term that covers the multitude of plausible situations during the independence continuum tasks. I need to learn about the touch therapy and its accurate use and ways to use the support and mobility procedures in the most accurate form (Williams, 2017). I have decided to improve my skills and be certified in conducting falls assessment and mini mental status examination because the safety issue calls the consequences of fall, injury and agitation or psychological instability to higher extent (Hickish & Roberts, 2019).


It is quite evident from this reflection that being a nurse, I have to put myself in the shoes of my patient and understand how I would feel if I have to take help for washing or bathing and shaving me or dressing me. It is unimaginable about the level of nervousness of the patient who is for the first time putting one’s personal functions in someone else’s hands. Thus, the nurse remains with the patient the most and can observe and identify the decline in personal functions at the first and can also support the best and at the foremost level. The nurse has to be advanced and more holistic in approach to assure that patient’s essentials in caring procedure are met on time and with efficiency.


Australian Nursing and Midwifery Council (2016). Registered Nurse Standards for Practice. Dickson, A.C.T.: ANMC

Hickish, D., & Roberts, D. (2019). The nurse-led model of hospice care. International journal of palliative nursing25(3), 143-149.

Holland, K. & Jenkins, J. (Eds.). (2019). Applying the Roper, Logan, Tierney Model in Practice (3rd ed.). Sydney, N.S.W.: Elsevier.

Miller, E., & Nambiar-Greenwood, G. (2019). TWO THE NURSE–PATIENT RELATIONSHIP. Communication Skills in Nursing Practice, 17.

Peate, I. (2019). A Systematic Approach to Nursing Care. Learning to Care E-Book: The Nurse Associate, 109.

Smith, S., James, A., Brogan, A., Adamson, E. & Gentleman, M. (2016). Reflections about experiences of compassionate care from award winning undergraduate nurses – What, so what…now what? Journal of Compassionate Health Care. 3 (6): 1-11.

Williams, B. C. (2015). The Roper-Logan-Tierney model of nursing: A framework to complement the nursing process. Nursing2019, 45(3), 24-26.

Williams, B. C. (2017). The Roper-Logan-Tierney model of nursing. Nursing2019 Critical Care12(1), 17-20.