Resolving the Case with Neuman’s System Theory
As a nurse in a primary care clinic, one meets a 48 year old female patient who has been diagnosed with Type 2 Diabetes Mellitus (DM). The patient is now engaged in nutritional counseling at the clinic. As one of the measures to manage her health, she is required to undergo weight loss; however, she experiences dietary challenges because she lives in a large family. It seems hard for her to make changes on diet composition since she has to cook for her husband, two children and father in-law. She feels that the other members of the family will not accept diet changes. Type 2 DM is a diseases characterized by failure of the body to produce enough insulin to maintain the required glucose level, or the resistance of the body to effects of insulin (regulation of sugar movements into the cells). A person diagnosed with Type 2 DM has to be helped to eat regular and well balanced meals that are lower in fat. The person also needs to consider matching the correct amount of energy in the foods she consumes so that she does not develop overweight. Being overweight may complicate her conditions further by increasing risks of stroke, cancer and heart disease.
The Betty Neuman System Model
The Neuman Systems Model is a theory in nursing that was developed by Betty Neuman and first published in 1972. It views human health as a condition in which all subparts and parts have to be in harmony. Neuman mentioned the subparts as physiological, psychological, spiritual, socio-cultural and developmental subparts. The theory therefore provides a system-based approach that unifies all factors that are concerned with human health. The Neuman’s holistic and multidimensional perspective is increasingly gaining relevance and reliability in both clinical and educational settings (McEwen, 2013). In educational institutions, it is employed as a guide in drawing curriculum for nurses and clinical practitioners. Despite the would-be nurses and clinicians learning about technical aspects of health, they are also taught about environments and subsystems in the patient’s health system. In clinical settings, each patient is individually viewed as a sensitive and open system that is susceptible to different variables in each subsystem; the person has to develop necessary and sufficient lines of defenses to deal effectively with environmental stressors in each subsystem (Martins, Echevarría-Guanilo, Silveira, Gonzales, & Pai, 2015).
Physiological subsystem involves wellbeing in the physiochemical structure and the general functioning of the body. Psychological subsystem involves wellbeing in emotions and mental processes. By socio-cultural subsystem, one has to look at wellness of the patient’s relationships with others and cultural expectations. Nurses also consider influences of one’s spiritual beliefs on his health, since medication would not be effective if religious factors are not well put into consideration. By development, nurses have to consider the patient’s stage of development and experiences in his or her life time (McEwen, 2013). Stressors can be unknown, known and universal. Stressors can also be intra-personal, inter-personal and extra-personal. Lines of defenses usually range from flexible line of defense, normal line of defense to line of resistance, and they will determine one’s capacity to respond to stressors in the environment (Neuman, & Fawcett, 2012). If lines of defenses are broken, one will adversely be affected by the stressors. On the other hand, if lines of defenses are strong, the body will easily deal with stressors without much intervention. A person’s totality involves three kinds of environments: internal, external and created environments. Therefore, it is important that the nurse understands the patient and his surrounding to render proper interventions (Martins, Echevarría-Guanilo, Silveira, Gonzales, & Pai, 2015).
In the Nueman’s model, the nurse’s response to the patient’s health problem(s) will depend on the stage of stressor’s detriment on his or her body system. During primary prevention, the patient’s system is yet to react to a stressor, and, thus, what is needed is strengthening his or her lines of defenses. Secondary prevention has to come after the system has reacted to a stressor. The nurse has to focus on preventing damages on the central core, and, thus, internal lines of defense have to be strengthened. Tertiary prevention has to occur after the patient has been involved in secondary prevention. The patient is thus supposed to add or reduce energy to the required level to facilitate reconstitution (Martins, Echevarría-Guanilo, Silveira, Gonzales, & Pai, 2015).
Assessments and Intervention Using the Nueman’s Model
Given that the patient’s health is a system, there have to be proper assessments and interventions on input –output perspectives. In this regard, the nurse attending to the patient has to assess and make proper interventions on all matters, energy and information exchange that can be experienced between the client and his or her environments. Developmental: According to Erikson’s stages of psychosocial development, the patient of 48 years is at adulthood stage. The person faces the dilemma of generativity versus stagnation. She is much preoccupied with making contributions to the society and guiding future generation. She wants to raise the family and better it, together with the society, or else she may develop feelings of stagnation. Intrapersonal factors: Physiological: Suffering from Type 2 DM, it is expected that the diseases will affect her intergumentary system, circulatory system, central nervous system and reproductive system. Psychological: Despite worrying about acceptability of diet changes in the family, she experiences psychological effects of Type 2 DM such as lack of concentration and pressure. Social-cultural: She lives in an extended family. Spiritual: The patient seems to embrace family religion.
Interpersonal factors: Developmental: She cares for others in the family. Physiological: She has to cook meals that are acceptable to everybody. Psychological: She is worried that other family members may not accept dietary changes regarding her diabetic condition. Social-cultural: The family decision affects everybody, and it can be hard for a woman to change it since it is patriarchal. Spiritual: Since the patient cares for the family much, it is possible that she embraces the religion of her husband. Extrapersonal factors: Physiological: She has to cook foods that are found in the community so that they are accepted by the family. Psychological: One believes in what the whole family and the community does as the best. Social-cultural: The family of the patient seems to embrace traditional or community diets.
The Neuman’s Systems Theory and Solutions
It is evident that although the nurse will strive to deal with the patient’s diabetes problem of the diet, her strategy may not be effective without family support. In order to combat stressors of the diabetic problem, the patient’s lines of defense have to be strengthened by the family and the society in general (intrapersonal and extra-personal environments) (Forsberg, Lennerling, Fridh, Karlsson, & Nilsson, 2015). Despite the social-cultural tendency of adhering to family decision, the patient is not self reliant to determine and afford her own affairs. Since she depends on the husband’s income, she has to cook meals that are traditional to him and the father-in-law. Nonetheless, she cares about her children and their attachments to parents and grandparents. To gain family understanding about the patient’s needs, the nurse will have to discuss with the family about her conditions. Upon such understanding, there can be mentions of traditional food that do not have a lot of energy and fats. Such foods will be those that the family uses frequently, so that nobody is left out in diet consideration. The foods should also be those that are used frequently in the community so that no difficulties of obtaining them are experienced. If such conditions are met, the family members will remain bonded to each other, and all of them will support the patient in dealing with her conditions (Forsberg, et al., 2015). However, interpersonal solutions to physiological and psychological problems will involve the health practitioner determining the level of the impact of diabetic stressors. The medication methods thus will be those that increase insulin sensitivity and glucose excretion, and decrease carbohydrate absorption. Otherwise, the patient can involve in physical excises, spiritual congregations and sessions, humor creating programs, social activities and so forth to reduce anxiety and diabetes related depression (Greco, 2016).
Scope and Limit of the Theory
References
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