spina Bifida

NURS 441- Nursing Theory 3spina BifidaSuad Ali

IntroductionRationaleSpina Bifida (SB)- most common neural tube defect in U. S.

Summary of presentationDefine SB & evidence for care Evaluation of the evidence of research articlePatient care design including TRUEPICAdvocate 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

What is Spina bifida?Incomplete development of the brain, spinal cord, and/or meninges Four types: occulta, closed neural tube defects, meningocele, and myelomeningoceleComplicationsOrthopedic, urologic, gastrointestinal Neurological, immunological, and neuropsychological Depression, mobility, learning disabilities

Spina Bifida Fact Sheet (2013, November 15). InNational Institute of Neurological Disorders and Stroke (NINDS). Retrieved February 16, 2014, from http://www.ninds.nih.gov/disorders/spina_bifida/detail_ spina_bifida.htm

Evidence for careConditions 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 SBAdvocacy 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

Evidence for careNursing theoryTransactional Model of Stress & Coping by Lazarus & Folkman

Sound basis for careResearch 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

Evaluation of the evidenceStudy methodsQualitative AnalysisData collection through semi-structured interviewsInterview guide used to target certain aspectsInterviews conducted by trained nurse researchers

ResultsTaking more responsibilityDevelopment of mobility competenceImportance 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

Evaluation of the evidenceCredibility/CritiqueNursing ResearchIRB approvalAppropriate literature review Purpose statement definedSample size- smallQualitative research design appropriateData 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

Evaluation of the evidenceLimitationsParticipants predominantly Caucasian Research limited only to female adolescents Research only discusses females with SB alone No other concurrent/related chronic illnesses discussed

Patient Care DesignCollaboration with interdisciplinary team including:Patients/familiesPhysiciansPhysical/occupational therapyDieticianPsychiatrist/therapistSocial Work

Patient Care DesignNursing DiagnosisAt risk for impaired social interaction r/t self-concept disturbance

Approach to careManage care with other health disciplinesEducate on disease processBe empathetic and encouragingWork towards improving or dealing with limitations

Ladwig, G., & Ackley, B. (2011). Guide to nursing diagnosis (3rd ed.) Mosbys Elsevier

Patient Care DesignApproach to care cont.Explore skills and aspirations with patientPromote family role Promote independence & self-managementWork towards improving self-esteem and social supportPatient SAFETY & ADVOCACY!

We Can Do It!!!

TRUEPICSituation: 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.

1. IDENTIFY

12yo boy with SBAccompanied by motherComplaints of muscle pain/ weaknessFeelings of depression & isolationDisplays difficulty with mobilityNo signs of use of mobility assistive device Mother does not believe in medsBoy refuses to go to schoolBoy quiet/looks for approval from mother before answering2. RELATEOr 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.3.UNDERSTANDthe 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.

12TRUEPIC4. EXPLAINthe significance of the situation to those involved based on their individual KSVMEProposition: In a way meaningful to the pt, explain the symptoms of depression and its effects on the pt's overall lifeAssumptions: Explain how the use of medications and assistive devices to help overcome physical limitations can greatly decrease depression which will decrease school absenteeConfounding 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 thoughts5. PREDICTwhat 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. INFLUENCEsomeone 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. CONTROLone or more variables in order to achieve a desired outcome or prevent an undesirable one. To control isnt 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.Advocate Nurse roleProviding empathetic, equitable careTreat each patient as a unique individualEstablish nurse-patient trusting relationshipImportance of autonomy & empowering patientsImportance of communication and social support

14Advocate nurse RoleNurses roleTreat patient with respect and dignityUse of therapeutic communicationAdvocacy/EmpowermentEnsure patient safety is NEVER compromisedEducation & promoting self-advocacyHelp to reduce patient pain/discomfortFocus on improving mobility

15Advocate nurse RoleSignificance to nursing practiceIncreased awareness of limitations with SBIncreased awareness of stigma with SBImproved quality of lifePromoted autonomy & independenceUse of various assessment tools for self-management

ReferenceLadwig, G., & Ackley, B. (2011). Guide to nursing diagnosis (3rd ed.) Mosbys ElsevierLazarus, 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.2410010304Sawin, 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.xSpina Bifida Fact Sheet (2013, November 15). InNational Institute of Neurological Disorders and Stroke (NINDS). Retrieved February 16, 2014, from http://www.ninds.nih.gov/disorders/spina_bifida/detail_ spina_bifida.htm