Betty Nueman, Dorothea Orem, and Sister Callista Roy's Nursing Theory Application

by - December 01, 2018



Case Number 1 Overview

Mr. Dela Cruz, a 45 year old, businessman, experienced severe chest pain following a meeting. In addition to the pain, he also experienced shortness of breath, increased heart rate and profuse sweating. Upon admission to the hospital, it was found out that he had a mild heart attack. Further investigation revealed that he had been having episodes of chest pain for the past 2 months but never took notice of it.

The Theorist and the Theory applied

A businessman named Mr. Dela Cruz experienced severe chest pain following a meeting. He was admitted in the hospital and it was found out that he is having episodes of chest pain for the past two months but never took notice of it. In this case the theory used is Betty Neuman’s System Model because it states here how was the relationship of Mr. Dela Cruz to stress and how he reacts on it.

Nursing problems arise

            Nursing problems like the ineffective communication and the improper understanding on the role of social problems arise in this case. The nurse and the client did not achieve the effective verbal communication because there are things that the client misinterpret regarding on how to properly handle the situation. Mr. Dela Cruz is lacking a health education because he didn’t know what to do regarding his case so he just choose to ignore his health problems. The nurse also failed to tell the client that social problems can be the cause of illness. In this situation, Mr. Dela Cruz is continuously giving all of his strength to work just to cope up with the social problems that arise in his surroundings. Little did he know, that too much indulgent to work can also lead to instability so he must be advice that there should be always a work-life balance to achieve and maintain a healthy lifestyle.

Relate and apply the theory and key concepts

Neuman System Model views Mr. Dela Cruz as an open system that responds to stressors in the environment. The stressors is the one that can potentially disrupt the systems stability that can lead to positive or negative outcome. The stressors that the businessman is experiencing is the extrapersonal stressors, which occurs outside the individual, due to his work and it can be seen that this stressors gave a negative outcome to his stability.
The flexible line of defense is the one that acts as a protective buffer for preventing the stressors to affect the wellness of the normal line of defense. In this case, Mr. Dela Cruz flexible line of defense is alarmed because of the chest pain that he is experiencing and eventually, he cannot cope up anymore because he didn’t take notice to it for the past two months. The normal line of defense is the adaptation level of health that changes over time in response to coping. Mr. Dela Cruz normal line of defense is now altered that results to his shortness of breathing, heart rate increasing, and profuse sweating. The lines of resistance is the one that is protecting the basic structure that consists the individual’s basic survival factors. It can be activated once the stressors penetrates the normal line of defense. In this case, the basic structure, core, or the energy resources that the line of resistance is protecting is now affected because of the mild heart attack that Mr. Dela Cruz experienced that results of him being admitted in the hospital.
Intervention must be done in this case and Neuman’s provides a nursing action that can help Mr. Dela Cruz retain, attain, or maintain his stability. The primary prevention strengthens the flexible line of protection by reducing the encounter of the stressor and its reaction. Since the stressor is now identified, the nurse can now help Mr. Dela Cruz by having health education and advise to change his lifestyle so that he can prevent the upcoming onset of stress and can also reduce the risk factors brought by the stressors. Secondary prevention strengthens the normal line of resistance of Mr. Dela Cruz by treating the underlying cause of the illness that he is experiencing right now. Tertiary prevention strengthens Mr. Dela Cruz lines of resistance by maintaining his wellness through enhancing and preserving his energy for readpatation of his wellness. If all of these prevention works, Mr. Dela Cruz reconstitution will be achieve because it symbolizes that he can now return to his system of stability.

Case Number 2 Overview

A home care nurse visits an elderly client who lives alone and is restricted to bed because of pain in his joints due to osteoarthritis. During conversation, the nurse finds that the client feels sad and inadequate due to his disability.

The Theorist and the Theory applied

An elderly client is restricted to bed for having an osteoarthritis. For being alone in his house, he feels sad because he thinks that he is not good enough to address his own needs due to his disability. With this kind of case, the theory applied is the Self – Care Deficit Theory of Dorothea Orem. It clearly states here, that the client is not capable to take care his own self because of the limited actions that he can only do. He don’t have someone that will take care of him when in times of need that’s why he feels so down because of his perception that he is not adequate enough in supplying his own continuous effective self-care.

Process on how the nurse identify the specific needs of the client

            All clients have different needs because they all have different capabilities that they can do for their own self. In this case, the nurse can identify the specific needs of the client by assessing the level of activity that the client can do for himself. The nurse can use the Eight Universal Self-Care Requisite that are known as goals that needs to meet in dependent care. The first three is the maintenance of a sufficient intake of air, food, and water. The nurse should make sure if the client is or not properly ventilated in order to help him to have a cozy environment that will help him to cope up for his current condition. Since the client doesn’t have the capability to make his own food, the nurse should know if he is eating a right kind and amount of food in order to help him maintain a well-balanced meal to keep the body functioning. The nurse should know if the client has a supply of clean water because if not, the nurse can make a way in getting him because a plenty supply of clean water means having a healthy body and also it can help to avoid foreign diseases. Fourth, is the elimination and excrements processes. Being bed-ridden for a long time can lead to constipation, so the nurse task is to ask the client if he is experiencing this problem because if he did, the nurse can make a solution in helping him to eliminate all of his body waste because if this is not treated it can cause internal damage to his body. Fifth, is the maintenance of balance between activity and rest. Strenuous activities is cannot be met by the client because he is old enough and plus the fact that he is bed ridden, but doing nothing can lead to loneliness. As a nurse, he or she should ask the client if there is something that he wants to do to keep him alive, alert, awake, and enthusiastic so that he can still feel that there’s still activity that he is capable to do. Sleeping and resting is a bit challenging to the client because of the continuous pain that he is experiencing. So the nurse should know if there is something that the client is specifically doing in addressing the pain and ask if its effective or not because if not the nurse can make a pain management plan that will help him to cope up the pain and also providing an adequate medication to lessen the burden. Sixth, is the maintenance of the balance between solitude and social interaction. Since he cannot go up and go outside to interact with others, being solitude is greater than being in a group. With this, the nurse should observe the client if there is a problem on the way how he interacts so that the nurse can take action right away in order to help the client not to feel that he is completely isolated in the outside world. Seventh, is the prevention of hazards to human life, human functioning, and human well-being. The nurse should observe the client’s surrounding if there is something that will potentially harm the client’s life and also ask if there is something that is bothering him so that the nurse can come up to solution for his safety. Lastly, is the promotion of human functioning and development within social groups in accordance to human potential and desire to be normal. In this case, it clearly shows that the client is not completely cope-up because of the feelings that he feel about his disability. As a duty of the nurse, he or she should boost up the client’s self-worth so that he is aware of the life that was given to him. That he should be strong enough for himself because having one can help for his health development. The nurse should emphasize that having a positive outlook in life will bring a positive effect to his well-being. And having a healthy life means that there is a chance that he can go back to what he was doing before and he can now interact to the people outside the four corner of his room.

Case Number 3 Overview

Mrs. P is a 35-year-old single mother with two school age children. Mrs. P suffered multiple facial injuries as a result of motor vehicle accident 5 months ago. The injuries have healed without complications but it left her with some scarring in the face.

You as the student nurse, used your observational skills, intuition, measurements, and interviewing skills to collect data. You also involved Mrs. P in the assessment to verify your own perceptions. You have verified that she has generally adapted well following the accident, with the exception of her view of herself. You observed that some of her behaviors are ineffective in relation to adjusting to her present situation. In your interview with her, she verbalized, "I hate social gatherings, as much as possible I avoid attending parties, meetings or any activity that involves mingling with other people. After the accident I develop this habit of wearing dark glasses and big hats whenever I go out. I even go to the extent of wearing heavy make up just to cover these scars on my face. I don't like it when people stare at me." As much as possible she avoids crowded places.

Next, you and Mrs. P had set some goals to help her adjust and help her accept herself again. You, in collaboration with Mrs. P., choose interventions based on current best practices which includes either changing stimuli or strengthening Mrs. P's adaptive processes. Evaluation focused on judging the effectiveness of the nursing interventions in relation to Mrs. P's behaviors. In addition, other nursing problems that were uncovered during the assessment, were also addressed simultaneously using the process described and incorporating best practices to provide appropriate nursing care.

The Theorist and the Theory applied

Mrs. P experienced a stimuli that results to an ineffective response due to not coping up fully from the accident that she had five months ago. She cannot adjust and accept herself again because of the big scar that left to her face. In order to solve this problem, an intervention was done to change the stimuli and strengthen Mrs. P’s self-esteem which is effective because the adaptation was occurred and other problems that weren’t uncovered are now being addressed. This case specifically used Sister Callista Roy’s Adaptation Model because it clearly states that the person experience an environmental stimuli and the nurse act to achieve the goal of treating it by assisting the adaptation and managing the environment to have the optimal level of wellness of the person.

Process on how the theory is utilized

The theory was being utilized in this case when the student nurse performs Roy’s six-step nursing practice. First, is when the student nurse assessed Mrs. P’s behavior stating that Mrs. P’s adapted well after the accident but not the view of herself. Second, when the student nurse assessed the stimuli of the behaviors of Mrs. P and categorize it as focal (the scar on the face), contextual (having a low self-esteem), and residual (the attitude toward herself because the scar on her face is a shame for her). Third, when the student nurse makes a nursing diagnosis of the client’s adaptive state. The student nurse recognize the cause of the problem because he or she used his or her observational skills, intuition, measurements, and interviewing skills to collect data. And also by involving Mrs. P in the assessment to verify his or her own perceptions. Fourth, when the student nurse set goals to promote Mrs. P adaptations. Fifth, is when the student nurse implemented an intervention and that is to change the stimuli and strengthen Mrs. P's adaptive processes. And lastly, is when the student nurse evaluated the effectivity of the nursing intervention made by relating Mrs. P’s behaviors when the stimuli was being manipulated.

Describe how interrelatedness is applied

There are two interrelated subsystems in Roy’s model. First is the primary, functional, or control processes subsystem, this is an internal processes that consists of regulator and cognator. The regulator is the bodies' attempt to adapt by responding automatically through neural, chemical, endocrine coping processes and the cognator is our mental coping mechanism that responds through the four cognitive-emotive channels which are the perceptual information processing, learning, judgement, and emotion. And the second subsystem is the secondary or effector, this is the external expressions of the internal process that consists of adaptive modes which are the physiological function, self-concept, role function, and interdependence. The physiological function is how the person interact with the environment through physiological process to meet the basic needs. In this case, the physiological function is when Mrs. P protects herself in the society from being judged by other people. The self-concept is how the person acts in the society. Here, Mrs. P use dark glasses and big hats and wear heavy make-up just to cover the scar on her face. The role function describes how the person behaves toward another person. The role function in this case is when Mrs. P don’t mingle with other people by being aloof to them because she is not confident enough to interact with them. And interdependence is how the persons interacts to the people of the society. This mode wasn’t achieve by Mrs. P because she usually don’t attend gathering, parties, and meetings because she wants to avoid crowded places.


References:

Alligood, M. (2018). Nursing Theorists and Their Work. Ermita, Manila: Elsevier Inc.

Iglesias, M. et al., (2009). Case Study Application of Dorothea Orem’s Nursing Theory. Retrieved            from https://www.scribd.com/doc/20791871/Case-Study-Application-of-Dorothea-Orem-                    s-Nursing-Theory

Secillano, R. (2008). Betty Neuman’s System Model. Retrieve from            https://www.slideshare.net/iversonny/betty-neumans-system-model


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