Within short-stay settings such as surgery or in areas where the assessor is uncomfortable with or unsure of the applicability of certain activities of daily living (ADL) it is common for the activities ‘sexuality’ and ‘death’ (as well as others) to be disregarded. These modifications depend upon the institution or the nurse and often results from a lack of understanding of the application of, or the factors within, the model. This is unfortunate, because this limits the application of the model and thereby reduces its efficacycitation needed.
Often clinical settings use a list of the activities of daily living as an assessment document, without any reference to the other elements of the model; Roper herself rejected the use of the list of ADLs as a “checklist” as she stated that it was essential not simply to read the title of the ADL, but to base assessment on knowledge of the scope of the ADL as assessed using the 5 key factors.3 Roper stated that if nurses themselves were uncomfortable discussing certain factors, they might assume patients also would be and thereby attribute the lack of assessment to the patient’s preference, when the patient’s opinion was never actually sought.5
Roper’s assertion leads one to believe that rather than delete or disregard activities of daily living, it can benefit the individual being assessed if the nurse uses the model more thoroughly and assesses the ADL fully, using the 5 factors, irrespective of the area in which the care is being received. Roper stated “The patient is the patient, they are not a different patient because they are in a different clinical area. Their needs are the same- it’s who will meet those needs that changes”.5 For example, “sexuality” as an activity of daily living refers not only to the act of reproduction, but also to body image, self-esteem and gender-related beliefs, roles, values and practices, all issues that could have a high degree of relevance for the individual about to undergo surgery. Another example is the ADL “death” which does not only apply strictly to the specific last moments of life, but also to the processes perceived to lead up to the eventuality of death, such as loss of independence, periods of ill health, fear of failure to recover, and fear of the unknown. These are all immeasurably relevant to most or all episodes of care.