Care of A Pregnant Woman Tested Positive for Coronavirus (COVID-19) Based On The Neuman Systems Model: A Case Report

ABSTRACT

Nurses play a crucial role in healthcare services and are responsible for providing high-quality care based on theories and models. Numerous models are available for nurses to plan care with. The Neuman systems model approaches the individual from a holistic and systematic perspective and is widely used in the nursing process. In this case study, nursing care based on the Neuman systems model was planned for a patient tested positive for coronavirus (COVID-19), which is a challenge the whole world is facing today. However, it is even riskier for pregnant women. Stressors were determined using the “six basic questions” in the Neuman systems model. Then, appropriate nursing interventions were planned to help the case experience less stress and adapt to the new situation more quickly. Nursing care consisted of primary, secondary, and tertiary protection. This was a case report of a pregnant woman tested positive for COVID-19. The Neuman systems model was used to plan nursing care within the nursing process. We believe that the results will serve as a guide for nurses facing challenges of the COVID-19 pandemic.

KEYWORDS

Nursing theory; Case report; COVID-19; Nursing; Pregnancy

INTRODUCTION

Novel coronavirus (COVID-19) is a zoonotic RNA virus that is likely to have first passed from bats to humans. COVID-19 is a public health problem as it may infect 60% of the world population [1]. The COVID-19 pandemic has been a traumatic event on a global scale that has caught the attention of the authorities, healthcare providers, and the public. The virus continues to spread despite drastic efforts to contain it [2]. As the COVID-19 has turned into a global pandemic, it has forced almost all countries to adopt strict measures [3]. Outbreaks, such as the COVID-19 pandemic, cause psychological problems as well as widespread health problems and mortality. Older people with one or more chronic diseases or a weakened immune system are at increased risk for COVID-19 [4]. Pregnant women are also a risk group. Mechanical and physiological changes during pregnancy make women vulnerable to some infections [5]. Immunological changes during pregnancy make women more likely to develop respiratory viral infections and severe diseases [6].

Pregnancy is a stressful and challenging period imbued with physiological, hormonal, and emotional changes [7]. Exposure to an infection during pregnancy can result in adverse outcomes affecting both the mother and the baby. Pregnancy is a physiological process, which makes women susceptible to viral infections [8]. which may cause miscarriage, preterm birth, malformation, or congenital infections, especially in the first or second trimester [9]. Although pregnant women constituted only 1% of the population infected with influenza A virus subtype H1N1 during the 2009 swine flu pandemic, they accounted for 5% of all deaths from H1N1 [10]. The Severe Acute Respiratory Syndrome coronavirus (SARS -CoV) and the Middle East Respiratory Syndrome coronavirus (MERS -CoV) are responsible for serious complications during pregnancy, including endotracheal intubation [11]. COVID‐19 is also a major risk factor for pregnant women, who require special attention to prevent, diagnose, and treat infections [8]. Lei et al. [12] reported fever, cough, muscle pain, weakness, sore throat, diarrhea, and shortness of breath, as well as fetal distress and preterm delivery in pregnant women who tested positive for COVID-19 (n=9) [12]. Huang et al. [13] and Wang et al. [14] conducted research on COVID-19 pneumonia during pregnancy and found a correlation between clinical features and prepartum and postpartum complications [13,14]. The researchers have concluded that it is of utmost importance that pregnant women adhere to infection control guidelines. The COVID-19 causes physiological mental and emotional problems [15]. in pregnant women. Pregnancy may sometimes cause post-stress chronic anxiety [16]. Pregnant women trying to adapt to physiological and psychological changes should be encouraged to develop resilience against stress [17].

Nurses can best administer nonpharmacological treatments to reduce stress levels in patients because they spend much more time with them than other healthcare professionals [18]. Nurses are responsible for maintaining and improving health and preventing and treating diseases. In this process, they utilize nursing models based on nursing theories [19]. The Neuman Systems Model (NSM) is one of the models that brings professionalism and scientificity to care and focuses on stress factors and responses to them [20]. For five decades, the NSM has been a comprehensive care and educational model for nurses seeking ways to improve the quality of care [21,22]. The model adopts a holistic approach and focuses on physiological, developmental, spiritual, psychological, and sociocultural variables to guide nursing interventions. It identifies all internal and external stress factors to help patients cope with their health problems [23]. It is used in different nursing fields, including the healthcare of pregnant women. It plays a key role in managing and eliminating stressors associated with health problems [24,25]. It addresses perceived stressors and provides necessary nursing interventions based on primary, secondary, and tertiary prevention measures [26]. Pregnant women are subjected to numerous stressors at varying degrees. The model serves as a guide for pregnant women to cope with stressors and protect their health.

The COVID-19 pandemic has affected the whole world and claimed hundreds of thousands of lives. This case study focused on the NSM to develop clinical strategies to protect pregnant women from pandemic-related stressors. Data were collected from a pregnant woman who tested positive for COVID-19. She was provided with nursing care within the scope of the NSM to help her cope with stressors. This section presented the details of the case and provided a care plan based on the NSM.

CASE REPORT

The study was approved by the Ethics Committee of Erzincan Binali Yıldırım University (06/25). Written permission was obtained from the Erzincan Mengücek Gazi Training and Research Hospital (62639109-929-E-448). The participant was informed of the research purpose. She was interviewed after verbal consent was obtained (July,2020).

Patient Profile

Mrs. G. was a 42-year-old housewife born in Erzincan. She was married for 18 years and had four children delivered through C-section. During one of her visits to the obstetrics clinic, she took a polymerase chain reaction (PCR) test because she presented with shortness of breath and cough. The test came out positive. She had no family members who tested positive for COVID-19. She was admitted to the COVID 6 Inpatient Service.

Complaints

Cough, shortness of breath, and muscle and joint pain.

Background

She had a lumbar disc herniation surgery five years ago. She had four C-sections. She had no chronic disease. She had no addictions (tobacco, alcohol, etc.).

Family History

She had family members diagnosed with diabetes mellitus and lung cancer.

Data Summary

The data were collected using a demographic characteristics questionnaire developed by the researcher and an NSM form based on a literature review [25]. The form addressed all NSM concepts (Table 1).

A Neuman Systems Model-Based Nursing Care Plan for the Case

The Table 2 below shows the primary, secondary, and tertiary prevention levels of NSM-based nursing interventions for the patient.

CONCLUSION AND RECOMMENDATIONS

The pandemic causes individual, family, and social problems. The COVID-19 infection takes its toll not only on the infected but also on their family. Treatment, care, adherence, and cooperation play a crucial role in the fight against infection. Raising public awareness and focusing on the disease is of paramount significance to counter the adverse effects of the pandemic, which is a critical challenge to the health and safety of the public. People without COVID-19 symptoms still spread the virus to others, and loosening restrictions let the pandemic get out of control. Pregnant women are at a higher risk of COVID-19 infection than the general population [27]. It is reported that flu and respiratory infections increase the risk of morbidity and mortality in pregnant women [28]. COVID-19 is also a dangerous infection for pregnant women because it can cause preterm birth or require respiratory support [14].

We collected data based on the Neuman Systems Model and adopted a holistic perspective to make nursing diagnoses and provide comprehensive care. The care helped the patient adapt to the situation and strengthen her line of defense. The pandemic continues to affect the whole world, and new information on transmission routes, epidemiology, treatment options, and care practices is coming in almost every day. Therefore, nurses should keep up with the literature that is being produced at an everexpanding rate. Nursing faculties should provide courses and training to raise students’ awareness of the threats of outbreaks in general, and the COVID-19 pandemic in particular.

ETHICAL STANDARDS

The study was conducted according to WHO Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects.

INFORMED CONSENT

Written informed consent was obtained from the patient whoparticipated in this study

ACKNOWLEDGMENT

The authors are grateful for their support throughout this study of the patients who involved in the study.

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