Loading

Annals of Nursing and Practice

Application of Betty Neuman Systems Model in Nursing Care of Patients with COVID -19

Case Report | Open Access | Volume 7 | Issue 2

  • 1. Department of Nursing Services, AIIMS, India
+ Show More - Show Less
Corresponding Authors
Poonam Joshi, Associate Professor, College of Nursing, AIIMS, New Delhi, India
ABSTRACT

Introduction: Nursing education is a recognized distinct discipline comprising of conceptual frameworks, models and theories. The integration of nursing theories into clinical practice is helpful in providing quality patient care.

Objective: to assess the applicability of the Betty Neuman Systems Model in the nursing care of a patient with moderate to severe COVID- 19.

Methodology: A clinical case was studied to assess the applicability of the Betty Neuman Systems Model in nursing care of a patient with moderate to severe COVID- 19 admitted in a COVID unit of a selected tertiary level care facility.

Results: We evaluated a patient with COVID-19 having moderate to severe illness according to Betty Neuman Systems model. We assessed the patient for all kinds of intrapersonal, interpersonal, and extra-personal stressors. After taking a detailed history and performing physical examination, 14 nursing diagnoses were framed based on North American Nursing Diagnosis Associations’ Taxonomy (NANDA, 2020). On the basis of obtained data, nursing care was planned on three levels of prevention. The data from the patient was further used in classifying nursing interventions and describing the outcomes.

Conclusion: The case study suggests that Betty Neuman Systems model can be used as a framework by nurses in providing quality nursing care to COVID-19 patients.

KEYWORDS

Betty Neuman Systems Model; COVID -19

CITATION

Joshi P, Kumari V, Ajesh Kumar TK (2020) Application of Betty Neuman Systems Model in Nursing Care of Patients with COVID -19. Ann Nurs Pract 7(2): 1116.

ABBREVIATIONS

SARS- CoV-2: Severe Acute Respiratory Syndrome Corona Virus 2; ARDS: Acute Respiratory Distress Syndrome; ICU: Intensive Care Unit; HCW: Health Care Workers

INTRODUCTION

Coronavirus disease 2019 (COVID-19) is a highly infectious pandemic disease, that has affected a large number of people world over. The disease is caused by novel corona virus, also known as severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) [1]. It was first time identified in Wuhan, Hubei, China in December 2019. Common symptoms of the disease include fever, cough, fatigue, and shortness of breath. A few patients may complain of loss of smell and taste as well during the illness [2,3]. The average time of onset of symptoms from exposure is typically found to be around 5 days, but may range from 2 to 14 days [3,6]. Majority of COVID -19 present with mild to moderate type of illness. Around 5-6% of patients become critically ill, who may progress to acute respiratory distress syndrome (ARDS) (ARDS), septic shock, multi-organ failure, and hyper-coagulable disorders, etc [4,5]. A critically ill patient with COIVD-19 require nursing care in an intensive care unit (ICU).

The virus primarily spreads from one person to another as a result of close contact or small droplets produced during talking, coughing or sneezing. The droplets may remain suspended for a period of half an hour to one hour in the environment. People may also get this infection less commonly, by touching contaminated surfaces [7]. The gold standard test for diagnosing COVID-19 is reverse transcription polymerase chain reaction (RT-PCR) test from a naso-pharyngeal swab [8]. However, rapid antigen detection test for isolating an antigen is also done, which is not a confirmatory test. Chest X ray and CT scan may be helpful in diagnosing a patient, whenever there is a high suspicion of infection based on clinical presentation.

A large number of patients require symptomatic treatment and only few patients, less than 5% require ICU care. Other recommended general measures to prevent transmission of infection include maintaining physical distance from other patients, frequent hand hygiene, maintaining respiratory hygiene and home quarantine for at least 14 days after the recovery [9]. Unfortunately, till now there is no vaccine or specific antiviral treatment available for COVID-19 [7]. All the drugs used for the management of COVID-19 are experimental drugs.

Nursing care in the management of COVID-19 is very crucial as these patients have no direct interaction with their families during hospitalization. Aim of the nursing care of the COVID-19 patient during his hospitalization is to promote recovery and improve the quality of life during quarantine period. Nurses are acting as front line warriors in management of COVID -19 patients. As per the protocol, nurses are expected to be donned in appropriate PPE including N-95 mask, gown/ coverall, goggles/ face shield, double gloves and shoe covers. This is required for the safety of the health care workers (HCW). All standard safety precautions were observed by the nurses in our unit, while taking care of COVID -19 patients as per the institute protocol.

Many nursing theories have made a significant contribution in expanding the body of nursing knowledge in nursing practice; which makes the modern nursing more significant and consequential to promote nursing as an ordered profession. Nursing theories describe and relate different aspects of practice and give as a framework for systemizing the nursing practice [12]. According to Neuman Systems model, nursing is a unique profession that brings stability in the client system. According to Betty Neuman, nursing is an “action which assist individuals, families and groups to maintain a maximum level of wellness, and the primary aim of nursing is to provide stability to the patient/client system, through nursing interventions in order to reduce stressors’’ [12]. This model emphasises on three level of prevention (Primary, Secondary, and Tertiary). The prevention focuses on keeping stressors and the stress responses of the patient from having a detrimental effect on his body. This theory has been tried out in some clinical conditions like stroke, and multiple sclerosis [13-14]. We decided to study application of Betty Neuman Systems model in a COVID-19 patient, in the present pandemic situation.

CLINICAL CASE REPORT

Mr ABC, a 47 year old male was admitted in COIVD -19 ward resident of Gwalior, Madhya Pradesh, India was admitted though emergency department after being referred from a private hospital. The presenting chief complaints of the patient were fever for 9 days associated with chills and rigors and shortness of breath for 6 days. There was no history of orthopnea or paroxysmal nocturnal dyspnea [PND] or cough or hemoptysis, but complained of some epigastric discomfort. He also complained of loss of appetite and wheezing. However there was documented weight loss.

On examination Conscious, E4 V5 M6, HR 79/min, BP 131/87 mm Hg, RR 18/min, SPO2 95% on 6-7 liters/ min

There was no past history of Hypertension, Coronary Artery Disease, Diabetes Mellitus, Jaundice or Tuberculosis or any previous surgery. He was a nonsmoker and consuming smokeless tobacco for 30 years and alcohol for 3 years.

INVESTIGATIONS

Rapid antigen test done on the patient was negative, but Reverse Transcription Polymerase Chain Reaction (RT-PCR) test was positive. Chest x ray revealed bilateral (B/L) Lower Lobes infection. High contrast Computerized Tomography (HCCT) revealed B/L consolidation with ground glass density and enlarged lymph nodes and mild hepatomegaly. Focused Assessment with Sonography for Trauma (FAST) scan showed B/L minimal pleural effusion, Inferior Vena Cava (IVC)> 50% collapsibility and left ventricle showing good contractility. ABG report of the patient showed pH 7.53, PO2 59 mmHg, PCO2 34.6 mmHg HCO3 - 28.6mEq/L, and moderately raised Serum Lactate (2.1mmol/L) level suggestive of ongoing organ dysfunction and sepsis. Clinical blood chemistry showed neutrophilia (75.4%) and lymphopenia (17.3%) and low Serum Potassium level (2.9 mEq/L).

TREATMENT

He was started on oxygen therapy with high frequency nasal (HFNC) cannula @7 L/ min. The medical treatment plan included Inj Piptaz (Piperacillin and Tazobactam) 4.5 gm IV TDS, Inj Azithromycin 500 mg BD, Inj Levofloxacillin 750 mg IV OD, Inj Pantoprazol 40 mg OD, Inj Paracetamol (PCM) 1 gm SOS and IV Lactated Ringer fluid @ 100ml/hr with 2 mEq/100 ml KCL. Patient was allowed to take oral fluids only for the administration of oral drugs. Oral medications such as Tab Vitamin C 500mg TDS, Tab Hydroxychloroquine 400 mg BD followed by 400 mg OD, Tab Zinc 50 mg BD were also started. IV fluid normal saline @ 100mL/ hr over 24 hours was started. He was voiding self.

Comprehensive nursing care was provided by a team of nursing personnel posted in COVID unit. They were donned in appropriate personal protective equipment (PPE). A primary nurse was made responsible for identifying and developing the nursing care plan. Patient was also provided with a triple layer surgical face mask to contain the droplets and respiratory secretions. Stressors and reactions of the patient were identified (Table 1,2).

Table 1: Stressors and reactions of Mr. ABC to COVID-19.

Stressor

Reaction

Physiological

Difficulty in breathing and wheezing

Fever

Epigastric discomfort

Loss of appetite

Inability to sleep

Psychological

Powerlessness and having weakness. Anxiety about 3 children, who were still studying and about their future.

Concerned about his wife at home, what will happen if something happens to him?

Did not share information about his sickness with his close friends and relatives

Developmental

47 year middle aged, studied up to middle level and an active member of the family

Socio-cultural

Had few relatives and close friends

Had not disclosed his status to all the relatives and family friends

Spiritual

Followed Hindu religion, He had faith on Hindu idol (Hanumanji), who will come for his support. Praying to the GOD while being in the hospital

 

Table 2: Nursing Management of the patient with COVID-19.

S.N.

Nursing Diagnosis

Nursing Goal

Level of Prevention

Nursing Intervention

Nursing Outcome

Physiological

1

Altered breathing patterns

To ease the work of breathing and maintain SPO2 within normal range

Secondary and tertiary

-Assessed respiratory rate and pattern

-Provided Prop up position

-Initiated oxygen therapy using HFNC cannula @ 7 L/ min

-Promoted humidification

-Monitored SpO2

-Encouraged coughing and deep breathing exercises while observing all respiratory precautions

- Provided frequent mouth care

Hypoxemia got corrected, patient was maintaining saturation > 95% with FiO2 of 60% and gradually be weaned off oxygen

2.

Altered body temperature

To maintain body temperature with in normal range

Secondary

-Monitored temperature of the patient every 4 hourly

-Administered antipyretic Inj Paracetamol 1gm IV SOS

-Given tepid sponging to reduce the body temperature

Patient’s temperature was maintained within normal range

3

At risk for hemodynamic instability

To maintain vital parameters within age appropriate normal range

Primary and Secondary

-Monitored vital signs like heart rate (HR) and blood pressure (BP)

-Recorded intake output and laboratory reports

Vital parameters were maintained within age appropriate normal range

4

Impaired nutritional status

 

To improve patient’s nutrition

Secondary

-Provided food in a quiet environment

-Given him easily digestible soft food, and small frequent meals

-Offered warm freshly cooked food according to his likes and dislikes

-Administered Vitamin C and Zinc Sulphate to improve the immunity of the patient

Patient was trying to increase his food intake

5

Activity intolerance

Assisting the patient in carrying out activities of daily living

Secondary

-Assisted patient in performing his activities of daily living on the bed itself

-Helped him to walk in his unit as per his tolerance

Patient was able to perform activities with minimal assistance

6

Disturbed sleep

Providing rest and improving his quality of sleep

Secondary

-Provided quiet environment for sleep with minimum disturbance

-Scheduled drug administration timing in order to minimize disturbances

Quality and duration of sleep improved

7

Potential to develop fluid overload and electrolyte imbalance

Restricting fluids to 2/3rd of maintenance fluid

 Maintaining normal lactate and electrolytes levels

Primary & Secondary

-Started IV fluids @ 100mL/ Hr in 24 hours

-Monitored serum electrolytes and lactate levels

Administered KCL 20 mEq/ L

No signs of fluid overload. Electrolyte and lactates were maintained within normal range

8

Potential to develop added infections

To protect the patient from developing super-added infections

Primary & Secondary

-Administered antibiotics as prescribed

Encouraged patient to observe hand hygiene and respiratory hygiene

Patient did not develop any added infections

Psychological

9

Psychological distress

In terms of anxiety and stress related to family and disease course

Helping patient to reduce his anxiety and stress related to family members

Secondary

-Calmed him down during acute respiratory distress

-Made oneself available to meet the needs of the patient

-Kept a call bell system for calling nurse for help

-Assisted him in learning relaxation techniques and keeping his negative thoughts away

Encourage patient to express his feelings

-Encouraged him to talk to his family after stabilization of his condition

members through video call on stabilization of his condition

His anxiety got relieved and communicated with his family telephonically

10

Fear of unknown and being away from his native place

Assisting patient to feel comfortable in a hospital away from his family and in a city not much known to him

Secondary

-Reassured him.

-Made oneself available to meet all his physiological needs

-Helped him in connecting with his family members telephonically

His fear of unknown was reduced to some extent

Socio-cultural

 

11

-Social isolation due to disease condition

-Stigma attached to COVID-19

Providing patient support and helping him to get rid of loneliness

Secondary

-Counseled him to understand the etiology of disease

-Encouraged family members to talk to the patient through video call

-Prepared him to disclose his status to his close friends

Patient felt relaxed after having talked to his family members and friends

Developmental

12

At risk for developing cardio-vascular respiratory and oral problems

Counselling him to give up alcohol and smokeless tobacco upon his complete recovery

Tertiary

-Counseled patient to change his life style

-Performed yoga and breathing exercises

-Abstain from alcohol and smokeless tobacco after his recovery

Will be able to abstain from alcohol and smokeless tobacco

13.

Knowledge deficit

related to unfamiliarity with disease transmission information

Educating patient about the disease COVID-19

Secondary and tertiary

-Provided health education to the patient about the disease transmission and ways to prevent the transmission of infection

Patient observed all precautions

Spiritual

14.

Spiritual distress

Involve patient in religious activities

Secondary

-Assisted patient in reciting Hanuman Chalisa (a Hindu devotional hymn (stotra) addressed to Lord Hanuman).

-Assisted him in offering prayers and arrange a spiritual person for the counseling

Patient appeared comfortable and relaxed after offering prayers

Nursing care plan was developed which included nursing diagnoses, nursing goals, nursing interventions and nursing outcomes. Nursing care was provided to the patient according to the developed nursing care plan.

DISCUSSION

Nursing care was given to the patient as per the identified stressors and his reaction to the stressors. He showed signs of improvement and was successfully discharged from the hospital with the advice of 14 days home quarantine. Results of our clinical case study are similar to the previous case studies done on multiple sclerosis and stroke patients. [13,14].

In the present clinical case study 14 nursing diagnoses were framed considering intra-personal, interpersonal and extrapersonal stressors and patient’s reactions to those stressors Nursing interventions were carried out as per the nursing care plan.

Application of Neuman’s systems model in COVID-19 patient helped us in identifying various intrapersonal, interpersonal, and extra-personal stressors present in the patient with COVID-19. Nursing interventions were planned and delivered, considering all three levels of prevention of care (Table 1,2). The application of this theory in the present clinical study revealed the effectiveness of the primary, secondary and tertiary prevention interventions. The model could be used for solving the problems of patient with COVID-19 by controlling the effect of all stressors on the client’s system.

CONCLUSION

Betty Neuman Systems model can be used as a framework by nurses in providing quality nursing care to COVID-19 patients. The model is effective in solving the nursing problems of patient with COVID-19, by controlling the effect of all stressors on the patient/client’s system.

ACKNOWLEDGEMENTS

Authors would like to thank Mahesh Kushwaha, who was admitted with COVID-19 disease in our COVID unit, and allowed us to use his case history for preparing the clinical case study.

REFERENCES

1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020; 395: 507-513.

2. Hui D, I Azhar E, Madani T, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J infect Dis. 2020; 91: 264-266.

3. Grant M, Geoghegan L, Arbyn M, Mohammed Z, McGuinness L, Clarke E, et al. The Prevalence of Symptoms in 24,410 Adults Infected by the Novel Coronavirus (SARS-CoV-2; COVID-19): A Systematic Review and Meta-Analysis of 148 Studies from 9 Countries. SSRN Electronic Journal. PLoS ONE. 2020; 15: e0234765.

4. Murthy S, Gomersall C, Fowler R. Care for Critically Ill Patients With COVID-19. The Journal of the American Medical Association. 2020; 323: 1499.

5. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. “Features, Evaluation and Treatment Coronavirus (COVID-19)”. Stat Pearls. Treasure Island (FL): StatPearls. 2020: 32150360.

6. Velavan T, Meyer C. The COVID-19 epidemic. Tropical Medicine & International Health. 2020; 25: 278-280.

7. Bourouiba L. Turbulent Gas Clouds and Respiratory Pathogen Emissions. JAMA Insights. 2020. 8. Centre for disease control and prevention. Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19). 2020; 1-5.

9. Feng S, Shen C, Xia N, Song W, Fan M, Cowling B. Rational use of face masks in the COVID-19 pandemic. The Lancet Respiratory Medicine. 2020; 8: 434-436.

10. Knight J. The Betty Neuman Systems Model applied to practice: a client with multiple sclerosis. Journal of Advanced Nursing. 1990; 15: 447-455.

11. George JB. Nursing Theories. The base for professional nursing practice. 6th ed. Pearson. 2010; 14. 12.Smith MC, Parker ME. Nursing theories and nursing practice. 4th edn. Philadelphia.

13. Sultan B. Application of Betty Neuman Theory in Care of Stroke Patient. Annals of Nursing and Practice. 2018; 5: 1092.

14. Ahmadi Z, Sadeghi T. Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal – Experimental, Translational and Clinical. 2017; 3: 205521731772679.

15. Vera M. Nursing Diagnosis: Everything You Need to Know. Nurseslabs. 2019

Joshi P, Kumari V, Ajesh Kumar TK (2020) Application of Betty Neuman Systems Model in Nursing Care of Patients with COVID -19. Ann Nurs Pract 7(2): 1116.

Received : 02 Aug 2019
Accepted : 12 Sep 2019
Published : 14 Sep 2019
Journals
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X