Case Study: Integrating Roy & Neuman Models in Head Injury Recovery

This case study focuses on the rehabilitation of a patient, Sgt. Eddie Johns, who sustained a traumatic brain injury and a broken leg from a roadside bomb in Afghanistan. It applies Sister Callista Roy's Adaptation Model and the Neuman Systems Model to guide nursing care. The Roy model emphasizes assisting the patient's adaptation in physiological needs, self-concept, interdependent relations, and role function, guiding nurses to assess behavior, identify stimuli, and set goals. The Neuman model provides a framework to address psychological, physiological, developmental, and sociocultural aspects, identifying stressors such as interpersonal, physiological, socio-cultural, and spiritual distress. The nursing plan based on Neuman's theory includes diagnoses, goals, levels of prevention, interventions, and expected outcomes, addressing issues like tissue perfusion, mobility, and spiritual well-being. The case study underscores the importance of listening to the patient's perspective to understand their beliefs and feelings for effective care.

N A M E O F T H E S T U D E N T
N A M E O F T H E U N I V E R S I T Y:
A U T H O R :
Case study of head
injury

•N A ME : SG T. E DDI E J O HN S
• HE A LT H I SSUE : T R AU M AT IC
B R A I N I N J U RY AND O N E B R O K E N
L E G
•PATI E NT H I ST O RY : HE WAS A I R
E VAC UAT E D B AC K STAT E SI DE F R O M
AF G HANI S TAN AF T E R T H E
R O ADSI DE B O M B W E N T OF F.
Patient history

SISTER CALLISTA ROY ADAPTATION MODEL
 First introduced into the psychology class while
working with the children as a pediatric nurse.
 The theory was developed in 1976 (Stone et al.,
2014).
 According to the theory, goal of nursing to
assist in adaptation for the individuals as well
as groups for each part of adaptation such as
self-concept ,physiological needs,
interdependent relations and self-concept
which will contribute to the health quality of
life.
Figure: Sister
callista roy
Source:(Stone et
al., 2014)

Diagram of Roy's adaptation model
Figure: Roy's adaptation model
Source: (Smith & Parker, 2015).

R o y ’ s a d o p t i o n m o d e l ( R A M ) i s o n e o f t h e w i d e l y a p p l i c a b l e
m o d e l s f o r n u r s i n g p r a c t i c e .
B y u s i n g t h e R A M , t h e n u r s i n g g o a l i s t o p r o m o t e a d a p t a t i o n f o r
t h e i n d i v i d u a l w h i c h w o u l d b e d o n e b y a s s e s s i n g t h e b e h a v i o r a n d
s t i m u l i t o f i n d a d a p t i v e a b i l i t i e s ( S e q u e i r a , 2 0 1 6 )
C o n t i n u a t i o n o f c a r e f o r S g t . J o h n s , f i r s t , a s s e s s m e n t o f b e h a v i o r
t h r o u g h g a t h e r i n g d a t a o f t h e b e h a v i o r o f t h e p a t i e n t i n e a c h
a d a p t i v e s y s t e m s h o u l d b e d o n e
B y u s i n g R A M , t h e s e c o n d w o u l d b e t h e i d e n t i f i c a t i o n o f e x t e r n a l
a n d i n t e r n a l s t i m u l i t h a t i n f l u e n c e t h e b e h a v i o r o f S g t . J o h n s
( A l l i g o o d , 2 0 1 7 ) .
A f t e r a s s e s s m e n t , a c l e a r g o a l w o u l d b e e s t a b l i s h e d c o n s i d e r i n g
t h e s t i m u l i a n d I n t e r v e n t i o n w o u l d b e t h e p a r t o f t h e c a r e f o r
a c h i e v i n g e s t a b l i s h e d g o a l
T h e l a s t s t a g e o f t h e n u r s i n g c a r e w o u l d e v a l u a t e t h e
e f f e c t i v e n e s s o f a n i n t e r v e n t i o n f o r g o a l e s t a b l i s h m e n t
Use of the Roy Adaptation
Model assist the nurse in
planning
Figure :nurse
practice
Source: (Alligood,
2017).

•T h e s e l f - c o n c e p t m o d e o f a d a p t a t i o n s y s t e m i s
c o n s i d e r e d a s t h e c o m b i n a t i o n o f f e e l i n g s a n d
b e l i e f s o f i n d i v i d u a l s i n t h e c u r r e n t s i t u a t i o n .
•T h e m o d e l e n c o m p a s s e s t h e p h y s i c a l s e l f a n d
p e r s o n a l i d e n t i fi c a t i o n . P h y s i c a l s e l f f u r t h e r
c o n t a i n s b o d y i m a g e a n d p e r s o n a l i d e n t i t y
c o n s i s t s o f t h e i r t h o u g h t s a n d m o r a l a n d e t h i c s
( P h i l l i p s & h a r r i s , 2 0 1 4 ) .
•R o y ’ s a d a p t a t i o n m o d e l g u i d e n u r s e s t o i d e n t i f y
t h e p e r s o n a l b e l i e v e s o f t h e p a t i e n t , f e e l i n g
a b o u t t h e m s e l v e s a s w e l l a s t h e m o r a l e t h i c s . I t
w o u l d g u i d e n u r s e s t o e m p o w e r p a t i e n t a n d
e l i m i n a t e a n y f a l s e b e l i e f s a n d m o r a l s a b o u t
t h e m s e l v e s f o r a d a p t a t i o n i n t h e e n v i r o n m e n t .
•I t g u i d e s n u r s e s t o s h o w e m p a t h y, k i n d n e s s , a n d
g e n e r o s i t y t o i d e n t i f y t h e c o n c e r n a n d b o o s t s e l f -
e s t e e m f o r t h e i r s e l f c a r e ( R o y e t a l . , 2 0 1 6 )
Influence of Roy's Theory in
guiding the nurse's actions in
promoting self-concept.
Figure: nursing
practice Source:(Roy
et al., 2016)

Importance of nurses to listen to the patient rather than
family members
In the current context, the self-concept of adaptation
model of Roy helps in the identifying the internal and
external stimuli that affect the behavior of the patient as
well as the morals ethics, beliefs of the patient (Roy,
2018).
 It is crucial for nurses to the to listen to the patient
words since It would reflect the personal beliefs and
thoughts and feelings of the patient.
Listening to the family members would reflect their
point view of the patient not the beliefs of the patient.

Neuman systems model
Neumann's system model originally developed in 1970.
The role of the model is to provide an overview of the
psychological, physiological, developmental and socio-
cultural aspect of human being (Smith & Parker, 2015).
It provided nurse a nursing focus as opposed to medical
focus. it provides a framework to identify the stress and
reaction to the stressor for the patient.

Diagram of Neumen's system model of nursing
Figure: neuman’s system
model of nursing
Source: (Smith & Parker,

Four stressor the case study:
Interpersonal stressor: being far away from family due to
long distance and being away from his friend
Physiological stressor: traumatic head injury and health
 Socio-cultural stressor: inability to work right now
Spiritual stressor: his hope towards doctor to give the give
the clearance for work.

Nursing plan based on based on Neumann ‘s theory of
nursing
Nursing
diagnosis
Nursing goal Level of
prevention
Nursing
Intervention
Nursing
outcome
Physiological
stressor : head
injury
•Prevention or
treat post injury
hypotension
•Prevention of
hypoxia
•Prevention of
intracranial
hypotension
primary •Ineffective tissue
perfusion
•In ineffective
breathing pattern
•Impaired
physical mobility
Patient will lead
meaningful life
without headache
and change in the
behavior
Physiological
stressor :broken
leg
To assisting the
patient to carry
out activities
without
dependence
Secondary Assist the patient
in moving out and
Walk with
assistance.
Patient will
perform the work
activities without
assistance
Interpersonal
stressor :
Far away from
family
Promoting patient
support and
getting rid of
loneliness
Secondary Encouraging
patient to interact
and call family
members
Feeling much
relax after calling
and interacting
with family
member
Spiritual distress Improve patient’s
religious
Secondary Assist the patient
in participating in
spiritual
counseling
Feeling very
satisfied and
willing to perform
religious activity

References:
Alligood, M. R. (2017). Nursing Theorists and
Their Work-E-Book. Elsevier Health Sciences.
Phillips, K. D., & Harris, R. (2014). Roy’s
adaptation model in nursing practice. MR
Alligood (Ed) Nursing Theory Utilization and
Application, 263-284.
Roy, C. (2018). Key Issues in Nursing Theory:
Developments, Challenges, and Future
Directions. Nursing research, 67(2), 81-92.