Case Study, Chapter 7: Grand Nursing Theories Based on Human Needs
After reviewing the theories, models, and frameworks from this chapter, consider the following Case Study and discuss the questions.
Case Study:
Mr. Juan Duran is a 60-year-old patient who has been coming to the Diabetes Clinic at the VA for a few months. One day, the Clinic Director, Jim Carlson, finds him wandering the hallway, appearing somewhat dazed, with a bag of supplies for blood glucose testing and insulin administration. Mr. Duran tells him that he has been instructed to start insulin for his diabetes but doesn’t know how. He doesn’t recall receiving any appointment or instructions. Mr. Carlson finds the Diabetes Nurse Educator, Jenny O’Connell, and asks her to fit Mr. Duran in for an unscheduled appointment.
Jenny O’Connell starts the appointment with a thorough assessment of Mr. Duran. In addition to the physical assessment, she covers psycho-social-spiritual issues. She discovers that Mr. Duran has had diabetes for about 10 years and, recently, his blood glucose levels and HgbA1c cannot be controlled with oral medications and exercise. The physician wants to start him on insulin. Here are notes that she took from her assessment:
· Sixty-year-old Mexican American patient. He is exceedingly polite and respectful of health care personnel (and does not like to interrupt or ask too many questions). He has been in the United States more than 50 years; he is a Navy veteran.
· Married; lives with wife in a comfortable apartment in Chula Vista, CA.
· Mr. Duran speaks fluent English, but his wife’s English is limited. They speak Spanish at home.
· Because Mr. Duran has limited vision, his wife has to administer the insulin.
· Had one (single) daughter, who was found murdered in the apartment parking lot less than 2 weeks ago, leaving Mr. and Mrs. Duran to care for her child.
· Mr. Duran seems befuddled by the insulin and syringes and is stoic when he talks about the loss of his daughter.
- Select one of the nursing models/theories from this chapter that will help Jenny in assessing Mr. Duran and planning for his care. Discuss why that particular model was selected.
- Based on the model selected, what additional information would Jenny want to collect/assess?
- Based on the model selected, how would Jenny initiate a plan of care (education) for Mr. Duran?
- Do you think that Jenny would assess and plan differently for Mr. Duran’s care if she used a different model (than the one you selected) for Mr. Duran? Why or why not?
TO BE RE-WRITTEN FROM THE SCRATCH
1.
Dorothy Johnson: The Behavioral System Model
The reason for selecting the model is that it is a grand model that focuses on one needs in a way at examining the behavioral system and relief in formulating the care for a patient. The model is a unique one that is based on discrete science with the theory being deductively derived. The theory focuses on the individual patient’s experiences with a disease more than the condition itself. The theory is well researched as it drew its propositions from Grinker theory of human behavior Selye on stress, Buckley and Chin on the systems models.
Jenny would confirm the blood group of Mr. Duran and also ask him about his pension plans and insurance. This information is vital when formulating the care plan as she will know the nature of the diet to put the patient. The relationship with the wife is essential to delve into that area to ensure that the patient stays in a conducive and controlled environment to prevent him from contacting high blood pressure. Other information is on the spiritual life of Mr. Duran as it can assist him to appreciate the condition he is recuperating I and will assist in the management of his diabetes.
I would organize the behaviors of Mr. Duran to achieve particular goals of diabetes management. Then I will differentiate them and classify them according to his prevailing conditions in setting up life choices. Accordingly, I will then formulate his administration of insulin in the maintenance of these behaviors through control and life choices.
I believe accordingly to her experience in the nursing practice she cannot use a different way in assessing the patient’s case while using a different model. This is because the model she utilized is well versed with others to achieve positive results……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..
Grand Nursing Theories Based on Human Needs
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