Mult Scler J Exp Transl Clin. 2017 Jul-Sep; 3(3): 2055217317726798. Zakieh Ahmadi Department of Medical Surgical Nursing, School of Nursing and Midwifery. Hormozgan University of Medical Sciences, Bandar Abbas, Iran Tabandeh Sadeghi Department of Pediatric Nursing, School of Nursing and Midwifery; Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran AbstractObjectiveThis study aimed to assess the application of the Betty Neuman systems model to the care of patient/clients with multiple sclerosis. MethodsThis clinical study resulted from the application of the nursing process to a patient/client admitted with multiple sclerosis in the neurological ward of a hospital in an urban area of Iran. ResultsA patient/client was evaluated according to the Neuman model. Intrapersonal stressors (physiological, psychological, socio-cultural, and spiritual), interpersonal stressors (being away from family and children) and extra-personal stressors (aggression and psychological pressure from the spouse) were found. Based on the examination, 12 nursing diagnoses based on the taxonomy of the North American Nursing Diagnosis Association International, and nursing care based on three levels of prevention that are important in the view of Neuman, are presented. The results were used in the classification of nursing interventions and the classification and nursing outcomes respectively. ConclusionsThe results suggest the desirability of care and patient/client satisfaction in the evaluation of nursing care based on the Neuman model. The model can be used as a framework to help nurses care for patients/clients. Thus, the application of this model and other models is recommended in the nursing care of patients/clients. Keywords: Multiple sclerosis, patient/client care, nursing models, Neuman systems model IntroductionMultiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) characterized by brain inflammation, demyelination, and axonal loss, which occurs primarily between the ages of 20–40 years.1 MS is the most prevalent inflammatory2 and the second most common cause of neurological disability in working-age adults. Since it usually strikes in the prime of life, frequently progresses to disability, and has no cure, MS can have a strong emotional impact not only on those who suffer from it, but also on the healthcare team.3 The range of symptoms that occur in MS can have disabling functional consequences for patients and lead to significant reductions in their quality of life and the ability of individuals to carry out their roles and job tasks.4 The goal of early disease management is to intervene before irreversible neuronal destruction happens, to delay the progression of disability, and to improve the quality of life.5 Currently, there is no known cure for MS, and the treatment goal of MS is the prevention of permanent neurological damage.6 Thus, the nature of the disease poses an obvious need for interdisciplinary services. Nurses have to play a key role in the interaction with patients/clients and their families to improve the patient/client’s health.7 The purpose of nursing care is to improve the quality of life of patients/clients.8 An effective way to promote nursing care is by applying nursing theories.9 The clinical use of nursing models and theories helps develop nursing knowledge.10 It is an important step to achieve the goals that guide the practical application of clinical and educational research.11 A wide variety of situations and phenomena make a certain degree of flexibility necessary in the selection of the models and nursing theories according to the circumstances.12 The Betty Neuman systems model is one theory that provides guidance at three levels of prevention.13 Neuman systems modelThe Neuman systems model is based on a general system theory and reflects the nature of living organisms as open systems in interaction with each other and with the environment. Within the Neuman model, the client may be an individual, a family, a group, a community, or a social entity. An important assumption of the Newman theory is: “each client system is unique, a composite of factors and characteristics within a given range of responses.”13 [p. 285] The human being is a total person, characterized by five variables: these include physiological, psychological, socio-cultural, spiritual, and developmental variables.14 The physiological variable refers to body structure and function. The psychological variable refers to mental processes in interaction with the environment. The socio-cultural variable refers to the effects and influences of social and cultural conditions. The spiritual variable refers to spiritual beliefs and influences. The developmental variable refers to age-related processes and activities.13 An individual organism is said to have a central “core” of basic survival mechanisms, such as temperature control, ego, and organ function.12 The core is protected by lines of defence. The outer layer is the flexible line of defence, and is variable, responding to the particular stressor. The inner or “normal” line of defence represents the state of wellness and adaptation of the individual. It is generally stable. The lines of resistance represent the internal factors that determine an organism’s response to a stressor. Stressors (intrapersonal, interpersonal, and extra-personal) are significant to the concept of environment and are described as environmental forces that interact with, and potentially alter, system stability.15 Intrapersonal factors include interactions contained within the client, such as conditioned responses. Interpersonal factors arise from interaction between two or more individuals, such as role expectation. Extra-personal factors comprise all interactions occurring outside the client, such as financial circumstances.16 Neuman defines the environment as all the internal and external forces surrounding the client, influencing and being influenced by the client at any point in time. She identifies three relevant environments: internal, external, and created.12 The internal influences are contained within the boundaries of the client’s system in other words, they are intrapersonal in nature. The external influences exist outside the client; and the created environment is unconsciously developed and is used by the client to support protective coping.17 She views health as a continuum of wellness to illness that is dynamic in nature and is constantly changing. Optimal wellness exists when the total system needs are completely met and illness exists at the opposite end of the continuum from wellness and represents a state of instability and energy depletion.12 Neuman believes that nursing is concerned with the whole person. She views nursing as a unique profession and believes that it is concerned with all the variables affecting an individual’s response to stress. The primary aim of nursing is the stability of the client system. This is achieved through nursing intervention to reduce the stressors. Neuman’s process contains three basic parts: nursing diagnosis, nursing goals, and nursing outcomes. Neuman stresses the importance of identifying the client’s and the caregiver’s perceptions and collaboration between the client and the caregiver in all stages of the process. She identifies three levels of intervention: primary, secondary, and tertiary (Table 1). Primary prevention takes place even before the client system can respond to a stressor that the purpose is to reduce the possibility of encounter with the stressor. Secondary prevention takes place after the client system responds to a stressor. Tertiary prevention occurs after the active treatment or secondary prevention stage that it focuses on readjustment toward optimal client system stability.13 This paper demonstrates the application of the Betty Neuman systems model to the care of patients/clients with MS. Table 1.Summary of Betty Neuman’s nursing process steps.
MethodThis clinical study resulted from the application of the nursing process mediated by the nursing theory of Betty Neuman to the care of patients/clients with MS in a neurological ward of a hospital in an urban area of Iran. One patient was studied in this study. In the first stage of the nursing process, an interview was drawn up with the purpose of guiding the research and determining the stressors. This clinical study was about single patient. After the assessment and data collection, 12 nursing diagnoses were established according to the taxonomy of the North American Nursing Diagnosis Association International (NANDAI), and nursing care based on three levels of prevention that are important in view of Neuman, was presented. The diagnoses were:
Experience reportsEvaluation of patients/clients to classify types of stress is posed by Neuman. Intrapersonal stressorsIntrapersonal stressors include the following needs: physiological, developmental, psychological, socio-cultural, and spiritual. Physiological
PsychologicalThe patient/client cannot express any feelings about the disease, but is depressed and anxious, looks tired and bored. In the case study, irritability and mental pressure by the patient/client’s husband were considered as intrapersonal factors that caused stress. Following stress and family dissociation, she was constantly agitated and anxious. She needed intense mental family support. Socio-culturalThe patient/client participates in artistic activities and believes that she will be mentally calm. But the patient/client cannot participate in sports classes, held by the MS center, due to problems of transportation and distance. DevelopmentalShe has been successfully engaged in meeting developmental needs appropriate to a middle-aged adult, for example: preparing for menopause. SpiritualConsiders herself a religious person. She believes in God and prays. She participates in religious ceremony. Interpersonal stressorsThese include (a) being away from family due to long distance; (b) being away from children due to remote education place; and (c) extra-personal stressors. ResultsThe nursing results were used for the classification of nursing interventions and the classification of nursing outcomes respectively (Table 2). Table 2.Nursing process adapted according to the Neuman theory for the multiple sclerosis (MS) patient/client.
DiscussionMS is a chronic disorder with no definite cure. So, the goal of treatment is to control the signs and symptoms, prevent further progress, and ensure better compliance from the patient/client.
Conflicts of interestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. FundingThe author(s) received no financial support for the research, authorship, and/or publication of this article. References1. Karagkouni A, Alevizos M, Theoharides TC. Effect of stress on brain inflammation and multiple sclerosis. Autoimmun Rev 2013; 12: 947–953. [PubMed] [Google Scholar] 2. Mitsonis CI, Zervas IM, Mitropoulos PA, et al. The impact of stressful life events on risk of relapse in women with multiple sclerosis: A prospective study. Eur Psychiatry 2008; 23: 497–504. [PubMed] [Google Scholar] 3. Patwardhan M, Matchar D, Samsa G, et al. Cost of multiple sclerosis by level of disability: A review of literature. Mult Scler 2005; 11: 232–239. [PubMed] [Google Scholar] 4. Toosy A, Ciccarelli O, Thompson A. Symptomatic treatment and management of multiple sclerosis. Handb Clin Neurol 2014; 122: 513–562. [PubMed] [Google Scholar] 5. Leist T, Hunter SF, Kantor D, et al. Novel therapeutics in multiple sclerosis management: Clinical applications. Am J Med 2014; 127: S2. [PubMed] [Google Scholar] 6. Ruto C. Care of patient/clients with multiple sclerosis. AORN J 2013; 98: 281–293. [PubMed] [Google Scholar] 7. Halper J and Holland NJ. Comprehensive nursing care in multiple sclerosis. Third ed. New York: Springer Publishing Company, 2011. 8. Ghanbari A, ParsaYekta Z, FaghihZadeh S, et al. Application in self care model to determine the influencing factors on QOL and patient/client’s metabolic condition. Daneshvar, Scientific-research Journal of Shahed University [Persian] 2004; 11: 74-65. 9. Sampaio FAA, Aquino PDS, Araujo TLD, et al. Nursing care to an ostomy patient/client: Application of the Orem's theory. Acta Paul enferm 2008; 21: 94–100. [Google Scholar] 10. Sadeghnejad Forotaghe M, Vanaki Z and Memarian R. The effect of nursing care plan based on “Roy Adaptation model” on psychological adaptation in patient/clients with diabetes type II. Evidence Based Care Journal [Persian] 2011; 1: 5–20. 11. Hamedanizadeh F, Mahmoudzadeh Zarandi F, Ebadi A, et al. Effectiveness of implementation of Orem self-care program on headache indices in Migraineur [Persian]. Kowsar Medical Journal 2010; 15: 155–161. 12. Knight JB. The Betty Neuman systems model applied to practice: A client with multiple sclerosis. J Adv Nurs 1990; 15: 447–455. [PubMed] [Google Scholar] 13. Alligood MR, Marriner-Tomey A. Nursing theorists and their work: Utilization & application, Elsevier Health Sciences. St. Louis: Mosby, 2014, pp. 281–293. [Google Scholar] 14. Graham MM, Lindo A, Bryan V, et al. Factors associated with stress among second year student nurses during clinical training in Jamaica. J Prof Nurs 2016; 32: 383–391. [PubMed] [Google Scholar] 15. Fulbrook PR. The application of the Neuman systems model to intensive care. Intensive Care Nurs 1991; 7: 28–39. [PubMed] [Google Scholar] 16. Bourdeanu L, Vivien D. Assessment of chemotherapy-induced nausea and vomiting in women with breast cancer: A Neuman systems model framework. Res Theory Nurs Pract 2013; 27: 296–304. [PubMed] [Google Scholar] 17. Navarro DJ. The impact of shift work on diabetes self-management activities. DNP Thesis. School of Nursing. University of Nevada, Las Vegas, USA, 2015. Articles from Multiple Sclerosis Journal - Experimental, Translational and Clinical are provided here courtesy of SAGE Publications What are 3 symptoms of myasthenia gravis?What are the symptoms of myasthenia gravis?. weakness of the eye muscles (called ocular myasthenia). drooping of one or both eyelids (ptosis). blurred or double vision (diplopia). a change in facial expression.. difficulty swallowing.. shortness of breath.. impaired speech (dysarthria). Which of the following is are the signs and symptoms of myasthenia gravis?There's no cure for myasthenia gravis, but treatment can help relieve signs and symptoms, such as weakness of arm or leg muscles, double vision, drooping eyelids, and difficulties with speech, chewing, swallowing and breathing.
Which finding is usually associated with a diagnosis of myasthenia gravis?The main test for myasthenia gravis is a blood test to look for a type of antibody (produced by the immune system) that stops signals being sent between the nerves and muscles. A high level of these antibodies usually means you have myasthenia gravis.
What is the most common presentation of myasthenia gravis?Droopy eyelids or double vision is the most common symptom at initial presentation of MG, with more than 75% of patients. These symptoms progress from mild to more severe disease over weeks to months. Difficulty in swallowing, slurred or nasal speech, difficulty chewing, and facial, neck, and extremity weakness occur.
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