Nsm And Bsm

NEUMAN SYSTEMS MODE L

A. CASE PRESENTATION B. THEORY APPLICATION & CORRELATION C. BRACKETT SYSTEMS MODEL presentation

Baby TOF is a 2-year-old girl, born on the 30th of October 2003. She was admitted in a tertiary hospital in the City of San Fernando on February 23, 2006 with an admitting diagnosis of Tetralogy of Fallot, T/C then Endocarditis. She was discharged on March 03, 2006, with a referral to a Cardiac Center in Manila. Baby TOF is the youngest of 5 children and according to Mrs. TOF, no one in the family suffered from the same condition that Baby TOF had.

case

At 4 months of life, Baby TOF was noted of having tachypnea, which progressed into difficulty in breathing accompanied with cyanosis for a few minutes, whenever she case cried.

No medicine or any procedure was done but they were asked to go to the tertiary hospital in Pampanga. case

Intravenous fluid (IVF) and oxygen (O2) therapy were started and blood was extracted. Chest Xray (CXR) was done after 2 days of confinement. The family was also asked to secure money for an Echocardiogram where a diagnosis of Tetralogy of Fallot (TOF) could be made.

case

During the course of hospitalization, Baby TOF still manifested tachypnea, occasional difficulty of breathing and cyanosis, noticeable especially when she’s restless. The mother could not recall the explanation of the doctors but knows that Baby TOF was suffering from a case heart problem.

Her manifestations of tachypnea, difficulty of breathing and cyanosis were still occurring but being managed with cuddling and soothing measures, or sometimes the symptoms subside spontaneously. The follow up check up in Manila did not materialize nor any other visits to the case doctor due to financial

According to Mrs. TOF, Baby TOF, had occasional episodes of difficulty of breathing and increasing cyanosis as she was growing but was never brought to the hospital again. Like the rest of the family, she only had common cough and colds that would usually last for a day case or two.

The mother further stated that she did not see Baby TOF joining so much on plays that involved running and/or jumping since she easily gets tired. Since the family knows that Baby TOF has a heart problem, they usually stop hercase

Two weeks prior to admission, Baby TOF had a fever, by touch, with increased difficulty of breathing. She was initially sponge bathed that did not offer relief. She was kept inside and was not allowed to play case with the other

Until, 1 week prior to admission, Baby TOF manifested increased respiratory effort, cyanosis with on and off fever and was noted to be having poor appetite and lethargy. case

6 hours prior to admission, Baby TOF was crying a lot, not comforted by cuddling or any other soothing measures with progression of symptoms into severe difficulty of breathing, described by the mother as 1 breath followed by shoulder lag, with cyanosis and eventually, sudden loss of consciousness for several minutes, which prompted admission to the tertiary hospital. She was admitted caseon February 23, 2006 at 5:30 p.m.

A. CASE PRESENTATION B. THEORY APPLICATION & CORRELATION C. BRACKETT SYSTEMS MODEL presentation

PHYSIOLOGICAL VARIABLE

PSYCHOLOGICAL VARIABLE

NEUMAN SYSTEMS MODEL

Baby TOF had an ongoing IVF with supplemental O2. It was evident that because she had cardiac structural defects, it was hard for the heart to redistribute oxygenated blood systemically. And due to a VSD, tachypnea is evident and cyanosis is seen whenever there is Overexertion or exhaustion. The nurse observed that the child sometimes withdraws herself from other children. Her mother instructed her to do so, and in turn, she may feel that she is unlike other “normal” children. Moreover, according to Erickson’s Psychosocial Theory, Baby TOF is under the stage of autonomy vs shame and doubt, however, she has not fully met this category since she experiences difficulty of breathing and cyanosis when she engages in active play.

theory application & correlation

SOCIO-CULTURAL VARIABLE

DEVELOPMENTAL VARIABLE

NEUMAN SYSTEMS MODEL

Since it was diagnosed that Baby TOF had cardiac structural defects, it was evident that the parents had no choice but to just wait and save for her operation. Distraught and worry were seen in the eyes of the parents and the mother told the researcher that it would be hard to come up with that sum of money, considering they barely had enough for every single day but the father affirmed that he will work twice as hard to help child. Babyhis TOF is a 2-year-old girl who was born with cardiac structural defects, thus, is limited to several activities that do not require excessive energy consumption.

theory application & correlation

NEUMAN SYSTEMS MODEL SPIRITUAL VARIABLE

The mother of Baby TOF placed a scapular around the neck of the child, telling her that prayers would help her get better. And because of this, the child always prays that she may play with her friends and do whatever “normal” kids do.

theory application & correlation

The nurse who practices holistic nursing principles is able to identify potential and real causes of problems, and help the client to move along a continuum toward optimal wellness. The researcher adopted the Neuman Systems Model to explain what nursing is and to prepare nurses to meet current and evolving health care needs of our community.

theory application & correlation

Person/Client The first key-nursing concept we need to understand to provide holistic care is the concept of person or client/client system. Neuman and Fawcett (2002) view the person as a client or client system. This client can be an individual, a family, a group, a community or a social issue. Baby TOF is an example of the client theory application as an individual.

& correlation

VARIABLES Physiological Variable Psychological Variable

Socio-cultural Variable

Development al Variable Spiritual Variable

NEUMAN & FAWCETT Bodily structure and internal function

NEUMAN SYSTEMS MODEL

RESERACHER

Biological structure, biological function, physical appearance, physical exam, past & present medical history, diagnostic tests, lab studies

Mental processes and internal environmental effects, internally and externally Combined effects of social and cultural conditions and influences

Mental status, intelligence, perceptions, self awareness, level of anxiety, feelings, defense mechanisms, self esteem

Age-related developmental processes and activities Spiritual beliefs and influences

Gender identity, chronological age, developmental age, developmental stages, developmental tasks, maturational crisis, level of maturity, moral development Personal meaning, values, love, hope, power, beliefs, connections, religion, sense of purpose

Family of origin, culture, ethnicity, education, family of choice, lifestyle, occupation

theory application & correlation

NEUMAN SYSTEMS MODEL

theory application & correlation

NEUMAN SYSTEMS MODEL

theory application & correlation

NEUMAN SYSTEMS MODEL

theory application & correlation

NEUMAN SYSTEMS MODEL

theory application & correlation

Person (Client/Client System) and Environment—How Do These Concepts Apply to Baby TOF? Baby TOF’s nurse reviewed her nursing history and her current situation. Based on this data the nurse identified several problems for Baby TOF. She currently is experiencing difficulty of breathing, anxiety, ineffective individual coping, altered role performance and spiritual distress. johann

pestalozzi

Client Structur e FLD

NLD

LOR

NEUMAN SYSTEMS MODEL

Variables Physio

Psych

Socio

Dev

Spi

Difficulty of breathing during activities

Anxiety due to lack of playtime or limited activities compared to normal children

Client could not play such as running or jumping like what normal kids do

Unable to experience play and less time with playmates

Guidance from her mother; “prayers can help her”

Normal rate of respiration if without cardiac structural deformities Cyanosis

Believes that she should enjoy going outside, playing with her friends

Complete family who does everything they can to help the client

Suffering is viewed as something that a child should not experience

Cries whenever she is not allowed to play by her mother

A two-year-old girl suffering from TOF and may think that she could die from exhaustion

A client with TOF, trying to understand that she is unlike other children Unable to express herself due to her condition

Because of her condition, she could not function as a normal child

theory application & correlation

NEUMAN SYSTEMS Application of Environment (Stressors) toMODEL Baby TOF Client Structure (Causes of the Problem) Intraperson al Stressors (within the client)

Variable Physio

Psych

Socio

Dev

Spi

Cardiac Structural Defects (Pulmonary Stenosis, Ventricular Septal Defect, Overriding of the Aorta, Right Ventricular Hypertroph y)

Ineffective coping since she is not mature enough, she could not fully comprehe nd why her mother wants her to refrain from playing

Due to her defect, she could not play, jump, or run like what other kids do

She could not feel what it is to be a “real” kid due to her condition

Wonders why though she prays at night, she still has her problem every day

theory application & correlation

NEUMAN SYSTEMS MODEL Interperson al Stressors (between the client and other people)

Afraid that every time she goes to the hospital, she will get hurt

Parents do not have the means to have her operated or even referred to a Cardiac Center.

Her playmates may tease her because that is what her mother wants

Her parents limits her from playing

Extraperson al Stressors (not people related)

Activities such as running or jumping are detrimenta l to her health

Questions why she could not live a normal life like other kids; compares herself to them

If she had enough toys, she would be happy even without her playmates

Client could not fully express her childhood

Client sometim es refrains from playing with siblings; she just plays with her None doll observe d at that time

theory application & correlation

Health is a manifestation of living energy available to preserve and enhance system integrity. The Neuman Systems Model wellnessillness continuum implies that energy flow is continuous between the client system and the environment. Client movement is toward wellness when more energy is being generated than used. When more energy is required than is being generated, movement is toward illness theory application and possible death (Neuman

& correlation

Neuman describes nursing as “a unique profession concerned with all variables affecting clients in their environment. Nursing is preventive intervention” (Neuman & Fawcett).

theory application & correlation

NEUMAN SYSTEMS for MODEL Primary, Secondary and

Neuman and Fawcett’s Definitions Tertiary Prevention as Interventions; and an Example of These Interventions for Baby TOF. Examples are Limited to “tet” or Hypercyanotic Spells Prevention Neuman & Fawcett’s as Definitions Interventi on Primary Intervention before a reaction to

Secondary

Tertiary

stressors occurs to reduce the possibility of an encounter with a stressor and strengthen the flexible line of defense. Includes health promotion. Intervention after a stressor reaction occurs and treatments to reduce their harmful effects.

Intervention following treatment of a stressor— readaptation, reeducation & maintenance of stability.

Example of Interventions for Baby TOF Instruct mother not to agitate the client by letting her get tired due to running, jumping, etc. or even scolding her or shouting at her, even scaring her that could make her cry. During an episode or a tet spell, position the client in a squatting position or flex her knees towards her abdomen. If she sees the client squatting after walking or running, just let her be. Instruct parents to bring the child to a hospital immediately if cyanosis persists. And refer the child to a Cardiac Center whenever they have the means to do so.

theory application & correlation

Nursing and the Nursing Process

theory

It is believed that the nursing process is the process of assisting an individual’s movement toward wellness. Nurses are concerned with “keeping the client system stable through accuracy in assessing the effects and possible effects of environmental stressors and in assisting client adjustments required for an optimal wellness level” (Neuman & Fawcett). application & correlation

A. CASE PRESENTATION B. THEORY APPLICATION & CORRELATION C. BRACKETT SYSTEMS MODEL presentation

•1.  The Core The researcher adopted the following nine core needs to further describe the client’s basic structure. These core needs are Anxiety; Circulation/Aeration; Elimination; Fluids and Electrolytes; Mobility; Nutrition/Metabolism; Safety; Sexuality; and Sensation/Perception.

brackett systems

2.  The Client The client, unlike the NSM, focuses solely on one individual. However, like Neuman’s model, the researcher opted to adopt the five variables that make up every person, namely: physiological, psychological, sociocultural, brackett systems developmental, and

•3.  Prime Factors These prime factors, which are age, intensity, control, and health, are factors, which differentiate one person from another, giving emphasis on each other’s uniqueness. In the NSM, Neuman may have said that her model may be used with a group of people for a client system, assuming there is synchrony among the members. However, the researcher affirms individualism – the good and ill brackett effects thatsystems one person brings or gives to

•4.  Coping Barrier

Mechanism

This barrier is just like the flexible line of defense, which acts as an accordionlike structure, which adapts to whatever situation. However, unlike the FLD, this structure’s main function is internally situated. This has a direct effect on the created environment made by the client and may extend even further than the normal line of defense and FLD. brackett systems

•5.  Continuum

Health-Illness

This is the horizontal bar intersecting the core. Evidently, it has the individual at the center, showing that health and illness are a continuum – two different states that any person may experience due to s stressor. And with it being situated at the center, this proves that brackett there is a dichotomy

systems

•6.  Environmental Pillar The environmental pillar emphasizes the fact that the environment has indeed a direct influence on the individual. It is the perpendicular bar intersecting both the core and the health-illness continuum. This was adopted from Dunn’s Model of Wellness, with the favorable environment being at the superior region and the unfavorable, at the inferior region. However, unlike Dunn’s model, the researcher opted to divide this pillar into 5 subportions – the environmental event factors related to stress appraisal: unpredictability, uncertainty, timing of event, duration of event, and the

brackett systems

•7.  Lines of Resistance •Like the NSM, this acts as the third line of defense for an individual that if penetrated by any stressor, may have detrimental effects to the client. This may also serve as the client’s tertiary prevention when the normal line of defense brackett is broken.

systems

•8.  Normal Line of Defense •This represents the individual’s system stability. It is considered to be the usual level of stability for the system or the normal wellness state and is used as the baseline for determining deviation from wellness for the client system. The normal line of defense has changed overtime as a result of coping with a variety of stressors. The stability represented by the normal line of defense is actually a

brackett systems

•9.  Flexible Defense

Line

of

The FLB, just like what was stated by Neuman in her model, acts as the system’s primary defense. Just like the Coping Mechanism Barrier, it is accordionlike and adjusts to the NLD basing on the client’s ability to cope with stress. It acts as a buffer that prevents stressors from invading the normal line of brackett systems defense, which could

10. Refocusing Refocusing, similar to the NSM’s reconstitution, is a state wherein the individual, or the client, refocuses his energies to eliminate the stressor and try to achieve homeostasis. However, unlike Neuman’s reconstitution, this is depicted in a wave-like form. The researcher believes that when a person tries to rechannel his remaining energy to achieve stability, it is never attained directly. The waveform represents the gradual change that the individual experiences in the

brackett systems

11. Degrees Prevention

of

In nursing, it is said that prevention is a primary intervention done by a nurse to any client. And because of this, prevention is subdivided into three stages: primary, secondary, and tertiary prevention. This is similar to what is stated in Neuman’s model. brackett systems

  12. Reaction This is depicted as the result of internal and external stressors. brackett systems

1 13. Nursing Since this model is applied to patients, it is imperative that we also include the nursing process. And everything that happens to the client system, nursing is entwined brackett systems to it.

14. Stressors The stressors are basically the internal and external stimuli that affect the individual. And stressors, in this model, have been subdivided into 2 – intrapersonal stressors, which happen within, and extrapersonal stressors, occurring outside. Unlike in the NSM, Neuman included the interpersonal stressors as 1 category, however, due to several criticisms and unclear justifications, the researcher opted to include interpersonal stressors as a sub-category of

brackett systems

15.

Collaborative

Arch The collaborative arch symbolizes other members of the health care team. These arches show that assessment and interventions are not sole responsibilities of a nurse but a collaborative response of several health care professionals to abrackett

systems

presented by ej brackett, rn