Holistic Nursing Approach to Susan S.’s Case: Metaparadigm of “Person” and “Environment”

QUESTION

Case Study

Susan S. is a 45 year-old Indigenous woman from Sechelt, BC and is a part of the
Shishalh Nation. She receives community case management services from the Indigenous Liaison Nurse for her concurrent disorder of MDD (Major Depressive Disorder) and Acquired Brain Injury. Susan is currently a student studying a Diploma course within the building trades industry.

Susan presented as a person having an “Acquired Brain Injury” as a result of a MVA last year as her primary disability, and with a secondary disability pertaining to a mental health disorder as a result of her acquired injury. Susan has ongoing physical pain and the inability to sit or stand for long periods of time. This together with a mental health disorder manifesting itself by depression, difficulty with sustained of concentration, short-term memory loss, fatigue, low self-esteem, difficulty with acceptance from her peers; and added issues of skill deficits in the areas of time management and writing. She presents as slim, wearing jeans and a sweater that are appropriate for the weather, but are in need of washing. Since her brain injury, she has been able to maintain a passing grade, but is increasingly finding it difficult due to her challenges with focus and memory.

During your assessment interview, Susan went to great lengths to explain her journey through her disability, to her eventual decision to take up a trades focused course. She was keen to have teaching staff well appraised of her disability issues in order for her educational accommodations to be taken seriously. During the discussion, Susan disclosed that since her motor vehicle accident she had become a very different person/personality compared to before the accident occurred. When asked to explain, Susan stated that she had a very different personality to the Susan she used to be. She said that although her body and physical features were the same in that everyone she knew recognised her, her personality was not, it was altered. She had become withdrawn and was not the fun-loving carefree person she used to be. Susan lets you know that she had changed her first name to one she thought suited her new persona; such was the depth of feeling towards self acknowledgment of this new personality. Susan needed to inform her world that she had changed.

BACKGROUND: Susan is single mother of a 25 year-old son. She lives within the Shishalh Nation band land and has a supportive community, but no other near relatives. Her son still lives with her and he has struggled with his own mental health challenges. Susan still supports him financially as he is unemployed at this time. She rents a 2-bedroom mobile home and was never able to replace her vehicle after the MVA, so she uses public transport. She finds the walk from her home to the bus stop difficult as it is long. She has a student loan that covers her tuition and rent only, she works part time at a local grocery store on the weekends to make ends meet, but it leaves her with little to no spending money. She is up to date on her bills, but only because she supplements her spending on her credit card, which is nearly maxed out. Her supplemental expenses include groceries, laundry services, utilities, transportation, and her sons’ expenses. She has one good friend, an elder in the community, whom she confides with. She shares with her friend that she left home early with a boyfriend, the father of her son. He was from Sechelt and a member of the Shishalh Nation. He became abusive and she left him, but he moved away while she stayed. She does not have a relationship with his family at this time.

1. Discussion on the concept of Metaparadigm “Person” and then application of the PSR Core Values and Principles to the concept of “Person” (as it applies to Susan’s case). From a nursing perspective, discuss the concerning areas and strengths for Susan. What two interventions in this domain based on Susan’s concerns/ areas of strength.

PART 2

2.Discussion on the concept of Metaparadigm  “Environment” and then application of the PSR Core Values and Principles to the concept of “Environment” (as it applies to Susan’s case). From a nursing perspective, discuss the concerning areas and strengths for Susan. Be sure to discuss two interventions in this domain based on Susan’s concerns/ areas of strength.

ANSWER

Holistic Nursing Approach to Susan S.’s Case: Metaparadigm of “Person” and “Environment”

Introduction

In the realm of nursing, a holistic approach is vital to providing comprehensive care to individuals like Susan S., who are dealing with complex physical, emotional, and social challenges. This essay delves into the metaparadigms of “Person” and “Environment” and applies the principles of the Psychosocial Rehabilitation (PSR) Core Values and Principles to Susan’s case. It analyzes concerning areas and strengths, followed by suggested nursing interventions within these domains.

Part 1: Concept of Metaparadigm “Person” and Application of PSR Core Values and Principles

The metaparadigm of “Person” in nursing encompasses the individual’s physical, emotional, and psychological dimensions, considering their unique identity and experiences. Applying the PSR Core Values and Principles to Susan’s case:

Concerning Areas for Susan

Identity Transformation: Susan’s disclosure of a significant personality change following her motor vehicle accident is a major concern. Her altered self-perception impacts her mental well-being and self-acceptance, potentially hindering her recovery journey.

Depression and Self-Esteem: Susan’s concurrent disorder of MDD exacerbates her feelings of low self-esteem, withdrawal, and difficulty with acceptance. These emotional challenges affect her ability to engage fully in her education and daily life.

Strengths for Susan

Seeking Support: Susan’s willingness to confide in an elder friend demonstrates her capacity for seeking social and emotional support, which is a strength that can be harnessed to aid her recovery.

Educational Pursuit: Susan’s determination to continue her studies despite her acquired brain injury and concurrent disorder highlights her resilience and commitment to personal growth.

Nursing Interventions

Person-Centered Counseling: Engage Susan in person-centered counseling sessions that focus on helping her explore and accept her new identity post-injury. Encourage self-expression and provide emotional support to facilitate her journey towards self-acknowledgment.

Mindfulness and Self-Compassion Practices: Teach Susan mindfulness and self-compassion techniques to address her self-esteem and depression. These practices can help her cultivate self-awareness, manage negative emotions, and promote self-acceptance.

Part 2: Concept of Metaparadigm “Environment” and Application of PSR Core Values and Principles

The “Environment” metaparadigm considers the external factors that impact an individual’s health and well-being. Applying the PSR Core Values and Principles to Susan’s case:

Concerning Areas for Susan

Financial Strain: Susan’s limited financial resources and credit card debt present a significant environmental stressor that may exacerbate her mental health challenges and limit her access to essential resources.

Social Support Network: While Susan has the support of an elder friend, her limited familial support system and her son’s own mental health struggles create an environment where additional emotional and financial burdens are present.

Strengths for Susan

Community Connection: Susan’s connection to the Shishalh Nation community and her supportive friend are sources of strength that can provide her with emotional and practical support.

Educational Pursuit: Susan’s engagement in educational activities reflects her ability to create a positive environment for personal growth and skill development.

Nursing Interventions

Financial Counseling and Resource Navigation: Collaborate with financial counselors to help Susan create a sustainable budget and explore available resources to alleviate financial strain. Provide guidance on managing credit card debt and accessing community support programs.

Social Network Enhancement: Facilitate connections between Susan and support groups within her community that focus on both mental health and acquired brain injuries. Encourage open communication with her son and explore potential avenues for his mental health support.

Conclusion

By analyzing the metaparadigms of “Person” and “Environment” through the lens of the PSR Core Values and Principles, nurses can develop a comprehensive understanding of Susan S.’s unique challenges and strengths. Tailored interventions, such as person-centered counseling, mindfulness practices, financial counseling, and social network enhancement, can be implemented to address her concerns and harness her strengths. Embracing this holistic approach ensures that Susan’s physical, emotional, and social well-being are prioritized, promoting her overall health and recovery journey.