Introduction
Scoliosis refers to a medical condition that causes the thoracic spine to curve away
from the normal body symmetry (Noshchenko et al., 2015, p.537). It brings about an
abnormal alignment of the human vertebras uniquely different from the normal body
symmetry, making the victims to have disproportionate body formations and anatomy in the
thoracic region (Weiss et al., 2016, p. 570). This case study establishes a nursing care plan for
the patient using the biopsychosocial model based on her medical diagnosis provided in the
guidelines. The scenario focuses on the fundamental nursing dynamics involved in a care
plan for adolescent idiopathic scoliosis (AIS), ineffective breathing patterns, impaired
physical mobility, disturbed body image, and inadequate knowledge. The paper also
discusses the nitty-gritty planning, evaluation, and implementation of care, effectiveness of
the treatment procedures involved, and rationale of the proposed dynamics using evidence-
based reasons for the plan.
This scoliosis case study will discuss a 15-year-old female who will be called Shade
to preserve the anonymity of the patient according to National Midwifery Council (NMC,
2020) and the use of the Engel biopsychosocial model 2017 to criticise the care given to the
patient and then make recommendations. Based on the case study, the patient was subjected
to spinal fusion when she was in the ward. It is worth to note that the patient underwent
spinal fusion during the treatment process. However, there lacks evidence of observation
when the patient was undergoing the surgical process. This means that the treatment process
bypassed the WHO and NICE guidelines of treating scoliosis. According to the NICE
guidelines, children suffering from scoliosis could be treated using bracing or surgery
(National Institute for Health and Care Excellence, 2015; GOSH NHS Foundation Trust,
2019). Although the patient was given care during hospital stay, the medical practitioners did
not give care after the discharge. This means that her physiotherapeutic recovery process has
been very slow. Even if she has been exercising, she still experiences the back pains, which
means that her physiotherapeutic recovery process has not been apt.
Biopsychosocial Model: Engel (1977)
According to Engel's Biopsychosocial (BPS) Model, a comprehensive assessment of
Shade's medical condition involves going beyond simply considering the biological factors
and also taking into account the psychological and social aspects that have potentially affect
the patient's conditions (Lehman et al., 2017). An idiopathic scoliosis patient is subjected to
biological problems such as back pains, perceived back flexibility and sleep disturbance,
, abnormal gaining of weight and disordered eating habits, which is present in Shade’s case
(Bialek, 2011). Based on the BPS model, the biological problems that Shade has been facing
are the back pains that she faces after undertaking sporting activities. The biological problems
increase the risk of mental disorders, such as depression, suicidal tendencies, and
psychological inadaptation. A patient coping style is mostly influenced by the social
interaction of the patient during puberty, it become disturbing may be detrimental when
Shade feels discriminated by fellow peers due to her physical appearance (Kotwicki et al.,
2013). Based on the BPS model, the psychological problem that Shade has been facing are
being unhappy with her body alignment. It is evident that the patient has been mentally
affected by the way she looks, which affects the image she has regarding her body. Shade
who has encountered social discrimination undergo acute depression, anxiety and mood
disorders (Carlson et al., 2013). Socially, Shade’s condition has been exacerbated by the
failure of care after discharge. Observation is one of the treatment methods that are
recommended by NICE in the treatment of idiopathic scoliosis. There is no evidence from the
case that the clinicians have been observing her after the discharge. Although she lives with
her parents, BPS requires social interaction between the patient and the healthcare
practitioners after discharge from scoliosis treatment. The failure for observation by
healthcare practitioners after discharge has affected Shade’s recovery, one year after
treatment.
Critique of the model's application in the clinical care for idiopathic scoliosis
The care that Shade received one year before does not meet the standards that are
recommended by the BPS model and the NICE guidelines. The approach that the healthcare
practitioners took in the treatment of this case fails to indicate that she was screened before
she could be taken for surgery. According to GOSH NHS Foundation Trust (2019), patients
should always be screened before they are taken for surgery considering that some scoliosis
cases may be very mild to require surgery. With the screening step bypassed, the kind of care
that Shade received in the hospital needs to be condemned. Moreover, the approach does not
comprehensively define patient-centered interviewing approaches that are repeatable and
elicit just the relevant patient information needed to define the model at each visit, making it
untestable for psychological and physiological diagnostic applications for patients exhibiting
the signs of idiopathic scoliosis (Lehman et al 2017, p.14). The case highlights that Shade has
been having recurrent back pains after her treatment a year ago. The biological aspect of BPS
requires that the correct procedures are followed during the treatment of scoliosis. The failure
Scoliosis refers to a medical condition that causes the thoracic spine to curve away
from the normal body symmetry (Noshchenko et al., 2015, p.537). It brings about an
abnormal alignment of the human vertebras uniquely different from the normal body
symmetry, making the victims to have disproportionate body formations and anatomy in the
thoracic region (Weiss et al., 2016, p. 570). This case study establishes a nursing care plan for
the patient using the biopsychosocial model based on her medical diagnosis provided in the
guidelines. The scenario focuses on the fundamental nursing dynamics involved in a care
plan for adolescent idiopathic scoliosis (AIS), ineffective breathing patterns, impaired
physical mobility, disturbed body image, and inadequate knowledge. The paper also
discusses the nitty-gritty planning, evaluation, and implementation of care, effectiveness of
the treatment procedures involved, and rationale of the proposed dynamics using evidence-
based reasons for the plan.
This scoliosis case study will discuss a 15-year-old female who will be called Shade
to preserve the anonymity of the patient according to National Midwifery Council (NMC,
2020) and the use of the Engel biopsychosocial model 2017 to criticise the care given to the
patient and then make recommendations. Based on the case study, the patient was subjected
to spinal fusion when she was in the ward. It is worth to note that the patient underwent
spinal fusion during the treatment process. However, there lacks evidence of observation
when the patient was undergoing the surgical process. This means that the treatment process
bypassed the WHO and NICE guidelines of treating scoliosis. According to the NICE
guidelines, children suffering from scoliosis could be treated using bracing or surgery
(National Institute for Health and Care Excellence, 2015; GOSH NHS Foundation Trust,
2019). Although the patient was given care during hospital stay, the medical practitioners did
not give care after the discharge. This means that her physiotherapeutic recovery process has
been very slow. Even if she has been exercising, she still experiences the back pains, which
means that her physiotherapeutic recovery process has not been apt.
Biopsychosocial Model: Engel (1977)
According to Engel's Biopsychosocial (BPS) Model, a comprehensive assessment of
Shade's medical condition involves going beyond simply considering the biological factors
and also taking into account the psychological and social aspects that have potentially affect
the patient's conditions (Lehman et al., 2017). An idiopathic scoliosis patient is subjected to
biological problems such as back pains, perceived back flexibility and sleep disturbance,
, abnormal gaining of weight and disordered eating habits, which is present in Shade’s case
(Bialek, 2011). Based on the BPS model, the biological problems that Shade has been facing
are the back pains that she faces after undertaking sporting activities. The biological problems
increase the risk of mental disorders, such as depression, suicidal tendencies, and
psychological inadaptation. A patient coping style is mostly influenced by the social
interaction of the patient during puberty, it become disturbing may be detrimental when
Shade feels discriminated by fellow peers due to her physical appearance (Kotwicki et al.,
2013). Based on the BPS model, the psychological problem that Shade has been facing are
being unhappy with her body alignment. It is evident that the patient has been mentally
affected by the way she looks, which affects the image she has regarding her body. Shade
who has encountered social discrimination undergo acute depression, anxiety and mood
disorders (Carlson et al., 2013). Socially, Shade’s condition has been exacerbated by the
failure of care after discharge. Observation is one of the treatment methods that are
recommended by NICE in the treatment of idiopathic scoliosis. There is no evidence from the
case that the clinicians have been observing her after the discharge. Although she lives with
her parents, BPS requires social interaction between the patient and the healthcare
practitioners after discharge from scoliosis treatment. The failure for observation by
healthcare practitioners after discharge has affected Shade’s recovery, one year after
treatment.
Critique of the model's application in the clinical care for idiopathic scoliosis
The care that Shade received one year before does not meet the standards that are
recommended by the BPS model and the NICE guidelines. The approach that the healthcare
practitioners took in the treatment of this case fails to indicate that she was screened before
she could be taken for surgery. According to GOSH NHS Foundation Trust (2019), patients
should always be screened before they are taken for surgery considering that some scoliosis
cases may be very mild to require surgery. With the screening step bypassed, the kind of care
that Shade received in the hospital needs to be condemned. Moreover, the approach does not
comprehensively define patient-centered interviewing approaches that are repeatable and
elicit just the relevant patient information needed to define the model at each visit, making it
untestable for psychological and physiological diagnostic applications for patients exhibiting
the signs of idiopathic scoliosis (Lehman et al 2017, p.14). The case highlights that Shade has
been having recurrent back pains after her treatment a year ago. The biological aspect of BPS
requires that the correct procedures are followed during the treatment of scoliosis. The failure
