Nancy Roper

Author of a model for nursing

Nancy Roper was a practical theorist. She produced a simple nursing theory, which has actually helped bedside nurses. Its influence is worldwide. There is not a student nurse in Britain who does not use her model, first published in her 1976 monograph Clinical Experience in Nurse Education. It is equally a framework for nursing in America and on the continent of Europe.

Nancy Roper, nurse educationalist: born Wetheral, Cumberland 29 September 1918; died Edinburgh 5 October 2004.

Nancy Roper was a practical theorist. She produced a simple nursing theory, which has actually helped bedside nurses. Its influence is worldwide. There is not a student nurse in Britain who does not use her model, first published in her 1976 monograph Clinical Experience in Nurse Education. It is equally a framework for nursing in America and on the continent of Europe.

Typically an advertisement for a staff nurse at Dr Stevens' Hospital, Dublin, in 2002 stipulated that the person appointed must use the model. It is now being adapted for the care of people with learning difficulties. What Nancy Roper set out was a common core of the nursing required by each patient, regardless of medical diagnosis or location in the health service, and was based on patients' everyday living activities.

It reminded the nurse to look at the whole patient. Some activities were obvious, such as eating and drinking, but she taught nurses also to look further, and to expect, and be prepared to cope with sexuality in their patients and death and dying.

John Adams, a lecturer in nurse education, explains the secret of Roper's contribution:

Good intentions on their own are not enough in nursing. You need some sort of framework to provide systematic care for people. Roper produced this. I know she was very sniffy about checklists, but checklists can be quite useful and safe things. When I was a student 30 years ago I would have found her list of activities very helpful. It is difficult to realise it now, but then there was no recognised framework. So you somehow had to remember everything from scratch. The very simplicity of the model helps to explain its universal usefulness.

Roper's mother had been a nanny, and when Roper started the nursing career which she had always determined to follow as a schoolgirl in Wetheral near Carlisle, she studied to be a registered sick children's nurse (gaining a gold medal at Booth Hall Hospital, Manchester), and then took her general training (collecting more medals at Leeds General Infirmary). It was now that she conceived the idea which was to make her a best-selling author and a nursing care innovator.

"During my two trainings," she wrote in the British Journal of Nursing two years ago,

I disliked being moved to various wards supposedly to gain experience in different aspects of "nursing". I was of the opinion that there were more commonalities than differences in the nursing experience available in these various wards.

In 1943, when Roper became a state registered nurse, several of the nurse teaching staff had been called up as members of the Territorial Army, although teaching was a reserved occupation. Roper was identified as having the necessary attributes for teaching, so she was offered a post as staff nurse in teaching. Unusually, therefore, she was a teacher before subsequently pursuing the customary career development stages of being a staff nurse in a variety of wards, followed by ward sister posts.

When she was invited to be senior tutor at Cumberland Infirmary, Carlisle, she insisted that she be sent to qualify as a teacher first. She gained a London University sister tutor's diploma in 1950. She started her overseas experience with a Royal College of Nursing study tour to Belgium in 1954 and gained a British Commonwealth Nurses War Memorial Fellowship to investigate nursing education in the United States and Canada. She was an examiner for the General Nursing Council and began a career as a book writer by updating Oakes' Dictionary for Nurses, compiling the ninth edition, which appeared in 1961. Her name also appeared on the spine of Oakes' Pocket Medical Dictionary. ("The same text as the nurses' dictionary, but published in a different cover," she noted.)

After 30 years as a nurse and nurse teacher she became, in 1964, a self- employed lexicographer and author. "As far as I know I was the first British nurse to take this step," she said. The first edition of Principles of Nursing appeared in 1967 (the fourth, as Principles of Nursing in Process Context, in 1988). Oakes' Dictionary became Livingstone's Dictionary and then Churchill Livingstone Nurses' Dictionary, seeing its 16th edition in 1994.

Another British Commonwealth Nurses Fellowship in 1970 at last enabled Roper to investigate the concept of a core of nursing in her studies for an MPhil at Edinburgh University. After she published the Roper model of nursing based on a model of living in 1976, she invited Winifred Logan and Alison Tierney to work with her on her research recommendations. The Roper model now became the Roper-Logan-Tierney model. Their The Elements of Nursing first appeared in 1980, a fourth edition ( The Elements of Nursing: a model for nursing based on a model for living) in 1996. Their The Roper-Logan-Tierney Model of Nursing: based on activities of living followed in 2000.

From 1974 to 1978 Roper was the first nursing research officer at the Scottish Home and Health Department. Here she worked increasingly with the Chief Scientist. She carried out several short-term assignments for the World Health Organization's European office in Copenhagen and the Eastern Mediterranean Office in Alexandria, giving an international dimension to her nursing experience.

Strangely, so influential a figure in world nursing as Roper received no state honour, nor did the Royal College of Nursing confer its fellowship on her, although as a student she had been active in its student nurses section and had formed a member of the guard of honour when Queen Mary visited the college headquarters in London in 1939. The British Journal of Nursing named her Nurse of the Year in 2003.

Today when the emphasis - at least from the Government, concerned perhaps to reduce the power of the medical profession - is on nurses' doing the work of doctors, Roper's statement of the purpose of nursing may begin to seem a little passé. But not in the eyes of the majority of the profession. Roper had her critics but she had every confidence in herself and her mission. She was totally dedicated to nursing and always expounding on nursing. She lectured in Durban, Frankfort, Oporto and Lisbon, in the Netherlands, the Azores and Finland. In her eighties she was still on the meetings circuit.

As to how she felt about the modern generation of nurses whom she had helped to form, she was full of praise for the care she received in her final illness at the Royal Infirmary, Edinburgh.

Laurence Dopson