Psychological- the impact of not only emotion, but cognition, spiritual beliefs and the ability to understand. This includes expectations and values based on class and status, and culture within the sociocultural factor relates to the beliefs, expectations, and values held by the individual patient for him or herself, as well as by others pertaining to independence in and ability to carry out the activities of daily living.
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.
She implored students to support the use of the model through promoting an understanding of these factors as an element of the model. It is not effective in a paternalistic environment where all care is provided for an individual even when self care is possible[ citation needed ].
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. 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.
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.
Her assertion leads to the conclusion that rather than deleting or disregarding activities of daily living, it can benefit the individual being assessed if the nurse uses the model more thoroughly and assesses the patient using the five factors in conjunction with the activities of daily living, regardless of the area in which the care is being received.