1 / 17

NURS 441- Nursing Theory 3 spina Bifida

NURS 441- Nursing Theory 3 spina Bifida. Suad Ali. Introduction. Rationale Spina Bifida (SB)- most common neural tube defect in U. S. Summary of presentation Define SB & evidence for care Evaluation of the evidence of research article Patient care design including TRUEPIC

mio
Télécharger la présentation

NURS 441- Nursing Theory 3 spina Bifida

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NURS 441- Nursing Theory 3spina Bifida Suad Ali

  2. Introduction • Rationale • Spina Bifida (SB)- most common neural tube defect in U. S. • Summary of presentation • Define SB & evidence for care • Evaluation of the evidence of research article • Patient care design including TRUEPIC • Advocate nurse role • Purpose statement: • To explore the experience of self-management of adolescent women living with SB Sawin, K. J., Bellin, M. H., Roux, G., Buran, C. F., & Brei, T. J. (2012, March 27). The Experience of Self-Management in Adolescent Women with Spina Bifida. Rehabilitation Nursing, 34(1), 26-38. doi:10.1002/j.2048-7940.2009.tb00245.x

  3. What is Spina bifida? • Incomplete development of the brain, spinal cord, and/or meninges • Four types: occulta, closed neural tube defects, meningocele, and myelomeningocele • Complications • Orthopedic, urologic, gastrointestinal • Neurological, immunological, and neuropsychological • Depression, mobility, learning disabilities Spina Bifida Fact Sheet (2013, November 15). In National Institute of Neurological Disorders and Stroke (NINDS). Retrieved February 16, 2014, from http://www.ninds.nih.gov/disorders/spina_bifida/detail_ spina_bifida.htm

  4. Evidence for care • Conditions addressed in the research study: • Developing self-management skills to combat vulnerability that goes along with SB • Achieving self-sufficiency with SB • Transitioning to adulthood with SB • Advocacy within self-management Sawin, K. J., Bellin, M. H., Roux, G., Buran, C. F., & Brei, T. J. (2012, March 27). The Experience of Self-Management in Adolescent Women with Spina Bifida. Rehabilitation Nursing, 34(1), 26-38. doi:10.1002/j.2048-7940.2009.tb00245.x

  5. Evidence for care • Nursing theory • Transactional Model of Stress & Coping by Lazarus & Folkman • Sound basis for care • Research focuses on assessment of self-management • Interventions on ways to enhance self-management • Increasing optimal care in female adolescents with SB Lazarus, R. S., & Folkman, S. (2006, February 22). Transactional theory and research on emotions and coping. European Journal of Personality, 1(3), 141-169. doi:10.1002/per.2410010304

  6. Evaluation of the evidence • Study methods • Qualitative Analysis • Data collection through semi-structured interviews • Interview guide used to target certain aspects • Interviews conducted by trained nurse researchers • Results • Taking more responsibility • Development of mobility competence • Importance of perseverance & dealing with stigma Sawin, K. J., Bellin, M. H., Roux, G., Buran, C. F., & Brei, T. J. (2012, March 27). The Experience of Self-Management in Adolescent Women with Spina Bifida. Rehabilitation Nursing, 34(1), 26-38. doi:10.1002/j.2048-7940.2009.tb00245.x

  7. Evaluation of the evidence • Credibility/Critique • Nursing Research • IRB approval • Appropriate literature review • Purpose statement defined • Sample size- small • Qualitative research design appropriate • Data collection methods appropriate Sawin, K. J., Bellin, M. H., Roux, G., Buran, C. F., & Brei, T. J. (2012, March 27). The Experience of Self-Management in Adolescent Women with Spina Bifida. Rehabilitation Nursing, 34(1), 26-38. doi:10.1002/j.2048-7940.2009.tb00245.x

  8. Evaluation of the evidence • Limitations • Participants predominantly Caucasian • Research limited only to female adolescents • Research only discusses females with SB alone • No other concurrent/related chronic illnesses discussed

  9. Patient Care Design • Collaboration with interdisciplinary team including: • Patients/families • Physicians • Physical/occupational therapy • Dietician • Psychiatrist/therapist • Social Work

  10. Patient Care Design • Nursing Diagnosis • At risk for impaired social interaction r/t self-concept disturbance • Approach to care • Manage care with other health disciplines • Educate on disease process • Be empathetic and encouraging • Work towards improving or dealing with limitations Ladwig, G., & Ackley, B. (2011). Guide to nursing diagnosis (3rd ed.) Mosby’s Elsevier

  11. Patient Care Design • Approach to care cont. • Explore skills and aspirations with patient • Promote family role • Promote independence & self-management • Work towards improving self-esteem and social support • Patient SAFETY & ADVOCACY! We Can Do It!!!

  12. TRUEPIC • Situation: 12 year old boy with spina bifida (SB). He came to the emergency room accompanied by his mother with complaints of muscle pain/weakness, feelings of depression and isolation. Mother also states that her son refuses to go to school. Displays difficulty with mobility with no signs of assistive device in use. Mother states she does not believe in medications. Young boy is very quiet and looks at mother for approval before answering questions. • The nurse is a new 23 year old nurse who just started working in the emergency department 6 months ago. She has had no previous exposures or experiences to children with SB and does not have a clear understanding of what the illness is and its accompanying signs and symptoms. 3.UNDERSTAND…the importance of the propositions, assumptions, and confounding variables. Proposition: “If pt continues to be isolated and his depression worsens then pt might have suicidal thoughts.” Significance of Assumptions: “If pt avoids his problems by not attending school then pt will not overcome depression.” Possible Confounding Variables: “If pt mother does not allow son to take proper meds and be more independent then physical symptoms of SB will not improve, leading to increased depression for pt. 1. IDENTIFY… 12yo boy with SB Accompanied by mother Complaints of muscle pain/ weakness Feelings of depression & isolation Displays difficulty with mobility No signs of use of mobility assistive device Mother does not believe in meds Boy refuses to go to school Boy quiet/looks for approval from mother before answering 2. RELATE…Or put the variables together to form propositions. Primary Proposition: “Pt is depressed and isolated due to negative self-esteem caused by complications of illness.” Possible Assumptions: “Pt is not attending school due to avoidance of being ridiculed or bullied.” Possible Confounding Variables: “Pt not having independence or proper treatment due to over-bearing mother.”

  13. TRUEPIC 4. EXPLAIN…the significance of the situation to those involved based on their individual KSVME Proposition: In a way meaningful to the pt, explain the symptoms of depression and its effects on the pt's overall life Assumptions: Explain how the use of medications and assistive devices to help overcome physical limitations can greatly decrease depression which will decrease school absentee Confounding Variables: Explain how lack of independence or control for the pt can greatly decrease self-esteem. Explain how lack of proper medications and assistive devices can greatly increase depression and risk for suicidal thoughts 5. PREDICT…what will happen in this situation if one or more variables are not changed. Proposition: If depression is not cared for and worsens pt will experience a decrease in self-esteem and increase in suicidal thoughts . Assumptions: If pt does not receive proper treatment for depression and physical limitations depression will increase and lead to possible suicide attempt . Confounding Variables: If pt mother gives pt control back and supports use of medications pt depression will lessen, self-esteem will increase and pt will leave isolation and attend school. 6. INFLUENCE…someone to change one or more variables in order to achieve a desired outcome or prevent an undesirable one. Proposition: Make sure pt and mother understand the various treatment options available for depression and other complications of SB in order to effectively treat symptoms. Assumptions: Make sure pt understands importance attending school and interacting with peers with the use of medications to help overcome depression and improve self-esteem. Confounding Variables: Make sure pt's mother understands the importance of giving some level of independence and control to her son, proper use of medications, and use of assistive devices for her son in order to overcome depression, have positive self-esteem, attend school, and interact with peers. 7. CONTROL…one or more variables in order to achieve a desired outcome or prevent an undesirable one. To control isn’t an issue of wanting to dominate or do what is unreasonable or unwanted, but simply a matter of changing one or more variables in order to bring about a desired outcome when influence is not possible, realistic, or advisable. - Pt and mother required to attend therapy sessions discussing the benefits of medications and other forms of medical treatments to help with symptoms of depression and complications of SB. - Pt mother receives therapy to understand negative effects of over-bearing parenting methods and informed of positive effects of allowing some independence and self-management for children with SB.

  14. Advocate Nurse role • Providing empathetic, equitable care • Treat each patient as a unique individual • Establish nurse-patient trusting relationship • Importance of autonomy & empowering patients • Importance of communication and social support

  15. Advocate nurse Role • Nurse’s role • Treat patient with respect and dignity • Use of therapeutic communication • Advocacy/Empowerment • Ensure patient safety is NEVER compromised • Education & promoting self-advocacy • Help to reduce patient pain/discomfort • Focus on improving mobility

  16. Advocate nurse Role • Significance to nursing practice • Increased awareness of limitations with SB • Increased awareness of stigma with SB • Improved quality of life • Promoted autonomy & independence • Use of various assessment tools for self-management

  17. Reference • Ladwig, G., & Ackley, B. (2011). Guide to nursing diagnosis (3rd ed.) Mosby’s Elsevier • Lazarus, R. S., & Folkman, S. (2006, February 22). Transactional theory and research on emotions and coping. European Journal of Personality, 1(3), 141-169. doi:10.1002/per.2410010304 • Sawin, K. J., Bellin, M. H., Roux, G., Buran, C. F., & Brei, T. J. (2012, March 27). The Experience of Self-Management in Adolescent Women with Spina Bifida. Rehabilitation Nursing, 34(1), 26-38. doi:10.1002/j.2048-7940.2009.tb00245.x • Spina Bifida Fact Sheet (2013, November 15). In National Institute of Neurological Disorders and Stroke (NINDS). Retrieved February 16, 2014, from http://www.ninds.nih.gov/disorders/spina_bifida/detail_ spina_bifida.htm

More Related