MIDTERM PROJECT IN THEORETICAL FOUNDATIONS IN NURSING

MIDTERM PROJECT IN THEORETICAL FOUNDATIONS IN NURSING

NAME: DUQUE, GEORGETTE FLOREANNE L YEAR & SECTION: BSN-1C
CASE SCENARIO:
Mr. Pedro Mendoza, a 67yr old Muslim, bedridden male patient, from Naga City,
Camarines Sur. It is said that he had a left sided stroke two years ago. His past medical
history revealed that he had diabetes mellitus and hypertension. He was taking treatment
from NICC Doctor’s Hospital. He had complained of pain in legs, weakness of whole
body, numbness of right hands finger, insomnia & urinary control. He has no friends and
his wife died a decade ago. He also worries about his daughter’s wedding in Mindanao
on how he will attend in his situation. He also thinks about new things such as engaging
into businesses.
ABSTRACT:
Nursing is a discrete body of knowledge that includes a framework, models, and

theories. Nursing theories are integrated into clinical practice to assist nurses appreciate
the distinctive contribution that nurses have made to health care. The Nursing Philosophy
of Jean Watson’s and Neuman system model can be used to assess the stressors that
affect the patient's system. Nurses are better equipped to employ three levels of
prevention as interventions to alleviate patient stress when using this model. When the
blood flow to a region of your brain is blocked or diminished, brain tissue is deprived of
oxygen and nutrients, resulting in a stroke. Within minutes, brain cells begin to die. A stroke
is a medical emergency that requires immediate attention because other consequences
can be avoided if intervention is taken early.
METHODOLOGY:
This document illustrates the nursing philosophy on how it will relate to the
application of Neuman’s conceptual model into stroke patient and enlightens the three
areas of nursing service, nursing research and nursing academe.
DISCUSSION OF THE CASE STUDY:
In this case study, the nursing philosophy that I chose is Jean Watson's Theory of
Human Caring. In connection with Betty Neuman’s System Model, the philosophy and
model jive together in this kind of study that aims to assess the application of these two
in the stroke patient.
NURSING PHILOSOPHY: Jean Watson's Theory of Human Caring
In this nursing philosophy, Jean Watson focuses on caring. She addresses how
nurses express care to their patients. She defines “Health as a high level of overall physical,
mental, and social functioning; a general adaptive-maintenance level of daily
functioning; and the absence of illness, or the presence of efforts leading to the absence
of illness.” This is the best philosophy to Mr. Pedro Mendoza’s case. It establishes a
foundation for the idea that nursing is more than just a profession; it is an endeavor to
offer care for a patient and help them reach their full potential as a person. In her view,
disease might be cured but illness would will remain because without caring, health is not
fully attained.
In her philosophy, there are 3 elements: Curative care, Transpersonal Caring

Relationship and Caring occasion or movements. She also stated seven assumptions and
ten primary carative factors which are Embrace: Altruistic Values and Practice Loving
Kindness with Self and Others, Inspire: Faith and Hope and Honor Others, Trust: Self and
Others by Nurturing Individual Beliefs, Personal Growth and Practices, Nurture: Helping,
Trusting, Caring Relationships, Forgive: and Accept Positive and Negative Feelings –
Authentically Listen to Another’s Story, Deepen: Scientific Problem Solving Methods for
Caring Decision Making, Balance: Teaching and Learning to Address the Individual
Needs, Readiness and Learning Styles, Co-Create: a Healing Environment for the Physical
and Spiritual Self which Respects Human Dignity, Minister: To Basic Physical, Emotional
and Spiritual Human Needs, Open: to Mystery and Allow Miracles to Enter.
In Mr. Mendoza’s case, among the ten primary carative factors of Jean Watson,
Co-create: A Healing Environment for the Physical and Spiritual Self which Respects
Human Dignity and Minister: To Basic Physical, Emotional and Spiritual Human Needs gives
emphasis to the situation. Mr. Mendoza gives off a kickback about his experiences and
in connection to co-create, Mr. Mendoza needs to be promoted the caring relationship
we created space for this patient to generate his/her own wholeness and healing.
And Lastly, He Reverently and respectfully Needs assisting with basic needs, with an
intentional caring consciousness, administering “human care essentials,” which
potentiate alignment of mind body-spirit, wholeness and unity of being in all aspects of
care.
NURSING THEORY: Betty Neuman’s System Model
For a background, according to nurselabs.com, A nursing theory developed by

Betty Neuman is based on the person's relationship to stress, response, and reconstitution
factors that are progressive in nature. The Neuman Systems Model presents a broad,
holistic, and system-based method to nursing that maintains a factor of flexibility. I chose
this system model in this case scenario because it serves its purpose to define the
relationship between parts and whole, the effects of circumstances, and the client's
contact with his or her environment, the framework for understanding the concept of
adversity is established.
The philosophy of Jean Watson and the conceptual model of Betty Neuman is a
good match because it jives together the ideas and concept by their holistic health care
approach between the patient and the nurse. The Betty Neuman’s model guides us
manage the stressors and with the Jean Watson’s, it makes the case study easier to
discuss and deliberate.
Figure 1: Betty Neuman’s System Model according to the stroke patient.

Table 1: The goal and intervention which are applied on this stroke patient are mention
NURSING LEVEL OF
S.N. NURSING GOAL NURSING INTERVENTION NURSING OUTCOMES
DIAGNOSIS PREVENTION
PHYSIOLOGICAL
-Eating in a quiet and clean

environment
Improving the quality of -Allow enough time to patient
Trying to eat
Nutritional the patient/client’s for eating
1.1 Secondary according to
imbalance appetite, nutrition, and -Eating frequent meals in
desire
proper diet Small amounts
-Offer food according to
patient likes and dislikes
Helping the
Patient trying to
patient/client
Activity -Assist the patient in moving perform
1.2 carry out activities Secondary
intolerance out of bed. daily life activity with
without depending on
-Walk with assistance. minimum assistance.
others
-Improve urinary
-Perform kegal muscle
incontinence by Little improvement in
exercises.
Urinary reducing number of urinary incontinence
1.3 Secondary -Reducing fluid intake in the
incontinence incontinences Skin integrity
evening to avoid waking up at
-Maintain skin integrity maintained
night
of perineal area
-Refraining from beverages

containing caffeine
Improving the status Sleep pattern
-Creating a quiet and peaceful
1.4 Disturb sleep and Secondary improves
environment
quality of sleep and rest to 6 hrs.
-Using cooling devices
-Using proper cover
-Non pharmacological
treatment
Patient will feel free from Pain reduces
1.5 Pain Secondary -Mind diversion
pain completely
-Message
-Exerxcise
-Administer medication
PSYCHOLOGICAL
Allowing the patient to

express feelings, moods, and
Helping the patient
Anxiety Secondary behavior
1.1 control and reduce her
Encouraging her to talk with
stress and anxiety
family
members His anxiety and
stress
reduce and able to
communicate
Learning relaxation techniques concern
Helping the patient and with family
have a proper and Secondary distraction of negative ideas

1.2 Hopelessness satisfactory and Encourage the family member
relationship, as tertiary to discuss with patient about
much as possible his
feeling.
SOCIOCULTURAL
Encouraging the family to Feeling much relax

call after
patient friends at home. meeting with

neighbor
Encouraging the family
Promoting patient friends. Feeling
Social member to
1.1 support and getting rid Secondary himself
isolation spend time with patient.
of loneliness as a part of family
Encouraging the patient to after
interact and communicate spending time with
with neighbors to get rid of family
loneliness members.
SPIRITUAL
Feeling very satisfied
Assist the patient in reciting
and
Quran,
Improve patient comfortable.
Spiritual veruses etc.
1.1 religious Secondary Happy and were
distress Assist him in offering prayer.
activity more
Arrange spiritual person for his
willing to perform
counseling
religious activity.
NURSING ACADEME
The Philosophy and Science of Caring by Jean Watson discusses how nurses
communicate with their patients. Nursing is all about caring, and it promotes health far
more effectively than a simple medical solution. Nursing practice, she argues, requires a
holistic approach to health care. Watson's nursing approach is similar to that of scientific
research. The first step is to examine the situation. This include observing, identifying, and
reviewing the problem, as well as formulating a hypothesis. The nurse then develops a
care plan to establish how factors will be investigated, as well as what data should be
obtained and how it should be collected. Intervention is the third step. This is the process
of putting the planned strategy into action, which involves data collection. Finally, the
nurse performs an assessment. This is the analysis of the intervention's data and outcomes,
as well as the interpretation of those outcomes. This could lead to a new hypothesis.
Betty Neuman’s System model contributed a new knowledge in nursing school. She
developed her Systems Model in 1970 as a technique to teach introductory nursing to
students by providing them with a holistic picture of patients that includes physiological,
psychological, sociological, and developmental components. It was first designed as a
graduate course guide, and "A model for teaching complete person approach to
patient problems" was published in the May/June edition of Nursing Research in 1972.
Neuman's model was improved and published in the book Conceptual Models for
Nursing Practice in 1974. The Betty Neuman Health-Care Systems Model: A Total Person
Approach to Patient Problems" was classified as a systems model. The term "patient" has
been replaced in this publication. Neuman's nursing theory is based on energy resources
that are surrounded by three things: several lines of resistance, which represent internal
factors that help the patient fight a stressor; the normal line of defense, which represents
the patient's equilibrium; and the flexible line of defense, which represents the dynamic
nature that can change rapidly over a brief span of time. The nurse's duty in the Neuman
Systems Model is to maintain the system stable by employing three layers of preventive.
The first is primary prevention, which safeguards the conventional line of defense while
strengthening the flexible line. Secondary prevention is utilized to enhance internal lines
of resistance, reducing response and increasing mobilization elements. Finally, after

therapy, tertiary prevention readjusts, stabilizes, and safeguards the patient's return to
wholeness.
NURSING RESEARCH
In nursing research, there will be 2 categories I will be discussing. The Related

research about Jean Watson’s philosophy and Betty Neuman’s Model; and a distinct
related research about stroke patients. Let’s start with Jean Watson. As stated above,
Watson's Theory of Human Caring, in this nursing philosophy, Jean Watson focuses on
caring. She addresses how nurses express care to their patients. She defines “Health as a
high level of overall physical, mental, and social functioning. According to the article,
“Healthcare interprofessional team members' perspectives on human caring: A directed
content analysis study by Holly Wei and Jean Watson”. As Watson's Human Caring Theory
continues to evolve and guide the discipline of nursing, the challenge is to find ways to
integrate it into practice. The purpose of this study is to describe interprofessional team
members' perspectives on human caring based on the Ten Caritas Processes®/ Caritas-
Veritas Literacy of Watson's Human Caring Theory within the Unitary Caring Science. This
is a qualitative directed content analysis study, taking place in a Children's Hospital in the
United States between November 2017 and April 2018. Information redundancy was
utilized to guide the recruitment. Data were collected via a one-time face-to-face
individual interview. A qualitative directed content analysis was conducted using
Watson's Ten Caritas Processes®/Caritas-Veritas Literacy as a coding framework. In this
research, Healthcare is a multifaceted environment composed of different services and
professionals. To ensure patient safety and the quality of the whole person/whole system
care, effective interprofessional collaborations are imperative. While interprofessional
collaboration is a complex process, Watson's Human Caring Theory can be an underlying
guide to enrich human-to-human relations and create a caring-healing work
environment. When human caring is applied in interprofessional teams, healthcare
professionals find a caring consciousness to care for oneself and each other, and thus
promote patient care. According to their research paper.
Let’s come now to the related research about Betty Neuman’s System Model. This
is not related to stroke, the diagnosis of Mr. Mendoza but this is research sample is
basically same on how we used Neuman’s Model. The research is entitled, “Application
of the Betty Neuman systems model in the nursing care of patients/clients with multiple
sclerosis by Zakieh Ahmadi and Tabandeh Sadeghi.” They explained abstract that
covered 3 subcategories: Method, Result and Conclusion. First is the method, this 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.
Second is about Results, A 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. Third is the conclusion. The 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.
For the last category, it is a distinct related research about stroke patients. This is
their research entitled,” Research progress in rehabilitation treatment of stroke patients:
A bibliometric analysis by Xiaodong Feng, PhD,1 Chengmei Liu,1 Qingchuan Guo,1
Yanjie Bai,1 Yafeng Ren,1 Binbin Ren,1 Junmin Bai,1 and Lidian Chen, PhD2”. They also
discussed same as the Neuman’s Research. They explained abstract that covered 3
subcategories: Method, Result and Conclusion. First is the Methods. This 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. Second
is the Results, A 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. Lastly, The conclusion. The 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.
NURSING SERVICE
As we go through, we can assess that it provides a nursing process structure that

instructs nurses on how to examine patient data holistically. Information processing and
goal-directed behaviors are guided by the Neuman system paradigm. There are three
categories in the Neuman system model. Nursing diagnosis, nursing aim, and nursing
outcomes are all terms used in the field of nursing. With these we may be able to know
the services we able about to conduct.
Nursing diagnosis: To make a nursing diagnosis, a nurse must collect thorough and
holistic patient data that takes into account all of the patient's variables. She identifies
the environmental stressors that have an impact on the patient's system. Before making
a nursing diagnosis, be sure the data is correct. Nursing diagnoses are prioritized based
on relevant information. Nutritional imbalance, exercise intolerance, disrupted sleep
pattern, pain in physiological variable despondency, anxiety in psychological variable,
social isolation in sociocultural variable, and spiritual anguish in spiritual are nursing
diagnoses for this stroke patient, as depicted in Figure 1.
Nursing goals are determined by mutual agreement between the nurse and the
patient, according to the Neuman system paradigm. Mutual agreement on the aim and
intervention is beneficial to the patient's overall health. For reducing patient stress, nurses
used three levels of preventive as interventions (primary, secondary, and tertiary) Table 1
shows the goal and intervention that were used on this stroke patient.
The evaluation of the goal and intervention is shown in the nursing outcomes. Table
1 shows the patient's results. The patient in the variable has a positive response. Except
for urine incontinence, which requires further care to improve, other physiological
symptoms have improved. After participating in religious activity, a patient's outcome
showed that he felt more satisfied and at ease. The patient claims that his stress level has
decreased significantly as a result of participating in religious activities.
The client system's link with the environment, health, and nursing is depicted in this
model. The connections between these ideas are reasonable and well-defined. This
model can be used in nursing practice, education, and research with ease. Her
classification of the client system into five variables: physiological, psychological,
developmental, spiritual, and sociocultural aids nurses in gathering data from many
perspectives. Her nursing process model is very effective in providing patient care, and
the three levels of prevention as an intervention show that it can be used in both
community and hospital settings. In general, this type is well-liked and well-suited for use
in nursing care.
Mr. Pedro Mendoza’s case scenario demonstrates how this model can be used in
stroke patient treatment. In this circumstance, the Neuman system model proved to be
quite effective in the treatment of long-term disease patients, such as stroke patients. This
model aids the nurse in comprehending why a patient behaves in a particular manner.
She evaluates all of the patient's stressors and then implements interventions as needed.
Overall, the Neuman system concept was a good fit for today's nursing practice. It
instructs nurses on how to collaborate with their coworkers, as well as with patients,
families, and communities. It provides nurses with a board-level adaptable
multidisciplinary framework. This approach is not simply directed at a person's
physiological standpoint. However, it also aids in dealing with the patient's psychological
and spiritual needs. These are the services shown overall.

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MIDTERM PROJECT IN THEORETICAL FOUNDATIONS IN NURSING

NAME: DUQUE, GEORGETTE FLOREANNE L YEAR & SECTION: BSN-1C

Nursing is a discrete body of knowledge that includes a framework, models, and

DISCUSSION OF THE CASE STUDY:

NURSING PHILOSOPHY: Jean Watson's Theory of Human Caring

In her philosophy, there are 3 elements: Curative care, Transpersonal Caring

NURSING THEORY: Betty Neuman’s System Model

For a background, according to nurselabs.com, A nursing theory developed by

Figure 1: Betty Neuman’s System Model according to the stroke patient.

-Eating in a quiet and clean

-Refraining from beverages

Allowing the patient to

Learning relaxation techniques concern

Helping the patient and with family

have a proper and Secondary distraction of negative ideas

Encouraging the family to Feeling much relax

patient friends at home. meeting with

with neighbors to get rid of family

of resistance, reducing response and increasing mobilization elements. Finally, after

In nursing research, there will be 2 categories I will be discussing. The Related

Intrapersonal stressors (physiological, psychological, socio-cultural, and spiritual),

As we go through, we can assess that it provides a nursing process structure that

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