NURSING APPLICATION

OF MODELING
REMODELLING THEORY

CASE STUDY

Alia is 42 years old mother of three children who is

hospitalized with unilateral breast cancer (Right breast).
She is scheduled for modified radical mastectomy. Alia was
relatively healthy until she find a lump in her right breast 1
week ago. She and her husband are extremely anxious
about her surgery.
Her husband informs the nurse that Alia has been abusing
alcohol since her diagnosis and neglecting her
responsibilities as mother.

ASSESSMENT AND PHYSICAL

EXAMINATION (MODELLING)
Patient is anxious and is concerned about her surgery, History reveals that patient is not
coping well as evidenced by ineffective role performance. Alia confides to the

admitting nurse that I can't stand of the idea that one of my breasts cut
off; I dont knowhow i am going to be able to even look at myself. She is
tearful and does not see how she will be able to continue her work as dress
designer
Height: 164cm
Weight: 58kg
Temperature: 37C
Pulse Rate: 88 BPM
Respiration: 16 breaths/mint
Blood pressure: 142/88 mm Hg
Diagnostic Tests:
Chest x-ray negative, CBC and urinalysis within normal limits.

NURSING DIAGNOSIS

1)

2)

Disturbed body image related to loss of right breast as evidenced by

patient verbalize negative feelings about self and body, and fear of
rejection.
Ineffective coping related to personal secondary to mastectomy as
evidenced by verbalization of inability to cope, substance abuse and
inability to meet role expectations

FIVE AIMS OF
INTERVENTIONS

1.

2.
3.
4.
5.

Build Trust
Promote Positive orientation
Promote perceived control.
Promote strengths
Set mutual goals that are health directed.

GOALS AND DESIRED

OUTCOMES (ROLE
MODELLING)

Goals:
1.
2.

The client will demonstrate effective coping strategies.

Patient will be able to incorporate changes in self concept without negative
self esteem.

Desired Outcomes:
3.

Client will participate in activities of daily living postoperatively.

4.

Identifies personal strengths that promote effective coping before

discharge.
Accepts support through the nursing relationship by day 2.
Verbalize positive statements about self before discharge.

5.
6.

NURSING INTERVENTIONS FOR INEFFECTIVE

COPING
(FIVE AIMS OF INTERVENTIONS)

Inter v ent io ns
1.

Provide an atmosphere of
acceptance.

2.

Provide factual information

concerning the diagnosis,
treatment, and prognosis.

3.

Appraise Alis Adjustments to

change in body image.

4.

R ati on al
1. Establish rapport is essential for
therapeutic relationship & support
client in self reflection
2.

Stressed clients often

misunderstood facts and require
frequent clarification.

3. Alteration in body image may be an

major issue for alia and should be
explored to facilitate interventions.
Arrange situations that encourage
4. Enhances a sense of control.
her autonomy

5.

Explore with her previous

methods of coping.

6.

Encourage verbalization of
feeling.

5.

Previous coping status assist both

client and nurse in capitalizing on
successful methods.

6.

Open, non threatening discussion

facilitate the identification of
causative factors.

NURSING INTERVENTIONS FOR DISTURBED

BODY IMAGE (FIVE AIMS OF INTERVENTIONS)

Inter v ent io ns

R ati on al

1.

Assist Alia to separate

physical appearance from
feeling of personal worth

1.

Detaching physical appearance from

her definition of self will promote a
more positive image.

2.

Assist her to discuss

changes caused by surgery.

2.

Open discussion of actual changes

assist alia in facing reality

3.

Monitor whether the Alia

can look at her chest.

3.

4.

Identify means of reducing

the impact of any
disfigurement through
clothing.

Ability to look at the mastectomy

site provides objective data about
Alis level of acceptance and self
perception

4.

Assist the client in identifying ways

in which she can enhance her
physical attributes.

5.

Meeting another person who has

successfully adjusted to mastectomy
can lower the Clients stress and
anxiety.

5.

Facilitate contact with

individuals with similar
changes in the body image.

THANK
YOU