EXPERIENCING PARENTAL CANCER: A CASE STUDY WITH APPLICATION OF NEUMAN’S MODEL

to understand, in the light of Betty Neuman’s Systems Model, the experience of a woman-mother with cancer, and identify the woman-mother’s needs and prescribe nursing interventions in classified language.

Method

a qualitative case study of a woman-mother of a teenager experiencing cancer. Data collection carried out in Coimbra, Portugal, in 2021, through a semi-structured interview, supported by a script based on Betty Neuman’s Systems Model. Data processing performed based on categorical content analysis.

Results

the analysis of a mother’s speech made it possible to identify categories in agreement with the model variables: physiological, psychological, sociocultural, spiritual and developmental. The difficulties most expressed by the mother were fear, changes caused by the disease and parental role performance. The nursing diagnoses were defined based on the focuses “acceptance of health status”, “fear”, “parental role” and “family coping”, associating them with the respective nursing interventions. Interventions focused on support and education.

Conclusion

the theoretical model contributed to understanding and identifying the needs of a mother experiencing parental cancer, facilitating the prescription of nursing interventions in classified language. The model proved to be relevant for future interventions in parents experiencing similar situations.

DESCRIPTORS
Parents; Cancer; Parenting; Nursing; Theoretical models

Domain	Category	Subcategory	Units of Meaning (UM)
Physiological variables	Changes caused by cancer	Side effects of chemotherapy	I vomited a lot. I have paresthesia of the upper limbs, the taste is altered, I have swelling of the legs and headaches. The effects were being violent, I had no strength. I forget easily, I have no concentration. I don’t have energy.
Psychological variables	Emotional changes	Fear	I really thought and felt that I might die. I never verbalized it, but I was afraid for my son. What would become of him, since he’s a kid. (...) it was a bit dark.
		Sadness	On a psychological and emotional level, I also broke down (...) I was not very well psychologically. Sometimes I felt an “emptiness”, I cried. I’m more emotional.
		Anxiety	The process is very long and causes anxiety. You always have to be getting strength. I was not prepared for this reality, sometimes I felt lost.
	Self-image		I had a hard time falling out my hair. The mastectomy was hard (...) the first time I saw it I was inconsolable. When I get ready, it’s coping. I had to grieve and I’m still doing it.
	Hospitalization		Mentally I wasn’t prepared. It cost me because of my son, because he missed me so much. One day, he told me, “When you were in the hospital, I would come home and not study, I would not do anything, I would just wait for you to call me”.
	Coping strategies		Talk to family and close friends. I held on tightly to everything I could and tried to speed up the process quickly. I didn’t read anything about the treatments, about anything. It was a way to protect myself (...) I never did anything without the physician’s guideline.
Sociocultural variables	Labour changes		I still have a certificate; I didn’t have the psychological conditions to be in front of a class. I really had to stop, because the head was no longer there.
	Socioeconomic repercussions		There are many more expenses (...) my husband needed to have a medical certificate. I was no longer able to help my parents who are sick, and I had to turn to support for them.
	Support networks	Family	I had support from my family, they helped me to get the stones out of the way. They said it was beautiful. My family never let me get away from them. (…), my husband started to give me more support and the children as well.
		Friends	My friends gave me the support they could, they supported me in everything (...) I felt that I was not alone (...) I am privileged.
		Health teams	I had support from the family physician, the surgeon, and some nurses. They were available to listen and support me. It was important to trust the team.
		Community networks	I never looked for support networks, I didn’t sign up for associations. This is my thing and when I have doubts, I ask and clarify.
Spiritual variables	Beliefs		I got angry with God and I’m still not reconciled. It’s not for thinking why me. Not. I thought no one deserved it.
Developmental variables	Self-care		In the shower they helped me wash my back (...) I didn’t feel well, but then it goes away. There is no right time, there is an adaptation.
	Changes in family tasks		I tried to keep the routines, but you can’t, because everything changes around us. I was the one who took care of the house and I didn’t have the strength to do some things. My husband had to take over and many things I did became his tasks.
	Family relations	Husband	My husband was not quite understanding the situation. After the mastectomy, he sometimes felt like pushing him away, but he never left me. He suffered and so did our relationship. He doesn’t like me to cry, he doesn’t know what to do. He spent more time at home worrying about me and the children (…).
		Children	The situation [my illness] shook them and my biggest concern was not me, it was them. When my daughter was worse, she guided the situation. My son was scared too, but then over time he matured. I didn’t want him to grow up because of this, but it helped him. He was always careful with me, even if he could go out, he didn’t come out to protect me. I felt that he was sad in the depths of his soul, worried about his mother.
		Family nucleus	My relationship with my husband and with my children has strengthened. It brought us together much more. We are all for the same goal. It’s not just my process, it’s the whole family’s.
	Parental role		I didn’t want my children to stop having the quality of life they had. I am a very attentive mother and I accompany my children in their studies, but at times I was more fragile and I did not give them the support they were used to. This situation compromised my role as a mother. I feel a little guilty about that. I didn’t have the strength, and at times my son had to orient himself. You didn’t have me there to support you.

Focus	Nursing diagnosis	Objective	Outcome criteria	Autonomous nursing interventions	Expected nursing outcomes
Acceptance of health status (10044273)	Impaired acceptance of health status (10029480)	Promote acceptance of mother’s health status throughout cancer experience.	That the woman-mother empowers herself with adequate mechanisms to facilitate the process of accepting her health status.	- Assessing attitude towards disease (10024192) - Assessing acceptance of health status (10026249) - Promoting acceptance of health status (10037783) - Promoting self-esteem (10024455) - Reinforcing capabilities (10026436) - Providing family support (10036078)	Acceptance of health status (10023499)
Fear (10007738)	Fear (10000703)	Reduce mother-woman fear during cancer experience.	That the mother-woman mobilize appropriate strategies to reduce fear.	- Counseling about fears (10026208) - Counseling about hopes (10026212) - Establishing rapport (10024396) - Providing emotional support (10027051)	Reduced fear (10027889)
Parental role (10014068)	Risk for impaired parenting (10015198)	Promote parental role of woman-mother during cancer experience.	That the woman-mother empower herself with appropriate mechanisms to perform parental role.	- Assessing roles (10026142) - Teaching adaptation techniques (10023717) - Encouraging positive affirmations (10024377) - Facilitating ability to perform role (10026277) - Providing emotional support (10027051) - Assessing self efficacy (10024280) - Assessing fear about being a burden to others (10026254)	Effective role performance (10027940)
Family coping (10034736)	Risk for impaired family coping (10032364)	Promote family coping and adaptation during parental cancer experience.	That the family take appropriate strategies to promote effective family adaptation and coping.	- Assessing family coping (10026600) - Supporting family coping process (10032859) - Providing family anticipatory guidance (10026375) - Reinforcing communication (10050309)	Effective family coping (10034770)

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Ana Filipa Domingues Sousa afilipas87@gmail.com