Who the hell are Roper, Logan and Tierney?

As I said in  some of the early posts in the blog , I used to be a Registered Nurse but this blog isn’t  really about that  period of my life, however it gives me a different lens on certain things I am experiencing as a ‘patient’ trying to navigate the NHS GIC system 

A commonly held belief  among trans people is that the assessments undertaken in the GIC are some kind of special torture imposed on trans people as a test or the mythical are you trans enough? Gatekeeping… 

This perception possibly pervades because as a rule trans people are often physically well and don't have a huge amount of experience as a patient in Physical Healthcare. 

So who the hell are Roper, Logan and Tierney? They are three Registered Nurses working in the UK in the 1970s and early 80s. 

What is their relevance to  to this ?  - they didn’t work in a GIC … 
They didn’t work clinically  in a lot of areas, however they did  create a nursing / assessment model that is in widespread use in the UK, at the core of that model are 12 ‘activities of living’  in what  the authors saw as "As a cognitive approach to the assessment and care of the patient, not on paper as a list of boxes, but in the nurse's approach to and organisation of their care" 

The 12 Activities of Living are 

  • Breathing
  • Maintaining a safe environment
  • Communication
  • Eating and drinking
  • Elimination
  • Washing and dressing
  • Controlling temperature
  • Mobilisation
  • Working and playing
  • Expressing sexuality
  • Sleeping
  • Death and dying

The Wikipedia article on the model contains the following  passage 

“ The following factors that affect 
Activities of Living are identified.[4] Nancy Roper, when interviewed by members of the Royal College of Nursing's (RCN) Association of Nursing Students at RCN Congress in 2002 in Harrogate [5] stated that the greatest disappointment she held for the use of the model in the UK was the lack of application of the five factors listed below, citing that these are the factors which make the model holistic, and that failure to consider these factors means that the resulting assessment is both incomplete and flawed. She implored students to support the use of the model through promoting an understanding of these factors as an element of the model.

These factors do not stand alone; they are used to determine the individual's relative independence (and requirements to restore independence) for each other activities of daily living.

Biological- the impact of overall health, of current illness or injury, and the scope of the individual's anatomy and physiology all are considered under this aspect. An example is how having diabetes mellitus causes the person's nutritional activities to differ from those of a person without diabetes.

Psychological- the impact of not only emotion, but cognition, spiritual beliefs and the ability to understand. Roper explained this was about "knowing, thinking, hoping, feeling and believing". One example of the application of this factor would be how having paranoid thoughts might influence independence in communication; another example would be how lack of literacy could impact independence in health promotion.

Sociocultural- the impact of society and culture experienced by the individual. Expectations and values based on (perceived or actual) social class or status, or related to the individual's perceived or actual health or ability to carry our activities of daily living. Culture within this factor relates to the beliefs, expectations and values held by the individual both for themselves and by others pertaining to their independence in and ability to carry out activities of daily living. One example is when caring for an individual of advanced age and how societies expectations and assumptions about infirmity and cognitive decline, even if not present in the individual, could influence the delivery of care and level of independence permitted by those with sufficient authority to curtail it.

Environmental- Roper stated in the interview above that this consideration made hers the first truly "green" model, as it recommends consideration of not only the impact of the environment on the activities of daily living, but also the impact of the individual's ALs on the environment. One example of the environment impacting ALs is to consider if damp is present in one's home how that might impact independence in breathing (as damp can be related to breathing impairments); another example, using the "green" application, would be how dressings that are soiled with potentially hazardous fluids should be disposed of after removal.

Politicoeconomic – this is the impact of government, politics and the economy on ALs. Issues such as funding, government policies and programmes, state of war or violent conflict, availability and access to benefits, political reforms and government targets, interest rates and availability of fundings (both public and private) all are considered under this factor. One example is how becoming eligible for housing benefit might impact a person's independence, especially if the current housing is poor or inadequate; another example is how living in a place where violence and conflict are the norm would impact the ability to self care. “

So where does this fit  with  the assessment process of the GICs ?

People object to to some of the lines of questioning in the assessment process  claiming that exploration of people’s home circumstances, education, childhood and their sexuality and health beliefs are unnecessary and that the GIC  just get on with prescribing etc … 

My own background in clinical practice  says to me -great - if someone is motivated and has done  their background reading and understands the criteria  and the current  evidence base that's great but not everyone presenting to a service, even after the  many months of the currently failing dismally with regard to  the 18 week target waits  that pervades the GIC system , will be that  well read, or they may well still be struggling  with  reconciling  some of the ‘are they  trans enough ?’ questions -  my  physical dysphoria  didn’t really kick in until i was on hormones and some of the emotional / cognitive stuff  started to happen...  


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