Betty Neuman's System Model

INTRODUCTION

• Betty Neuman’s system model provides a comprehensive flexible holistic and system based perspective for nursing.
  
• It focuses on the response of the client system to actual or potential environmental stressors and the use of primary, secondary and tertiary nursing prevention intervention for retention, attainment, and maintenance of optimal client system wellness.
  

HISTORY AND BACKGROUND OF THE THEORIST

• Betty Neuman was born in 1924, in Lowel, Ohio.
  
• BS in nursing in 1957
  
• MS in Mental Health Public health consultation, from UCLA in 1966.
  
• Ph.D. in clinical psychology
  
• First published in 1972 as “A Model for Teaching Total Person Approach to Patient Problems” in Nursing Research.
  
• Then refined and published in the first edition of Conceptual Models for Nursing Practice, 1974, and in the second edition in 1980.

DEVELOPMENT OF THE MODEL

Neuman’s model was influenced by:

• The philosophy writers deChardin and Cornu (on wholeness in system).
• Von Bertalanfy, and Lazlo on general system theory.
• Selye on stress theory.
• Lararus on stress and coping.

BASIC ASSUMPTIONS

• Each client system is unique, a composite of factors and characteristics within a given range of responses contained within a basic structure.
  
• Many known, unknown, and universal stressors exist. Each differ in it’s potential for disturbing a client’s usual stability level or normal LOD (Line of Defence).
  
• The particular inter-relationships of client variables at any point in time can affect the degree to which a client is protected by the flexible LOD against possible reaction to stressors.
  
• Each client/ client system has evolved a normal range of responses to the environment that is referred to as a normal LOD. The normal LOD can be used as a standard from which to measure health deviation.
  
• When the flexible LOD is no longer capable of protecting the client/ client system against an environmental stressor, the stressor breaks through the normal LOD
  
• The client whether in a state of wellness or illness, is a dynamic composite of the inter-relationships of the variables. Wellness is on a continuum of available energy to support the system in an optimal state of system stability.
  
• Implicit within each client system are internal resistance factors known as LOR, which function to stabilize and realign the client to the usual wellness state.
  
• Primary prevention relates to G.K. that is applied in client assessment and intervention, in identification and reduction of possible or actual risk factors.
  
•  Secondary prevention relates to symptomatology following a reaction to stressor, appropriate ranking of intervention priorities and treatment to reduce their noxious effects.
  
•  Tertiary prevention relates to adjustive processes taking place as reconstitution begins and maintenance factors move the back in circular manner toward primary prevention.
  
• The client as a system is in dynamic, constant energy exchange with the environment.
  

MAJOR CONCEPTS

Content

• the variables of the person in interaction with the internal and external environment comprise the whole client system
  

Basic structure/Central core

• The common client survival factors in unique individual characteristics representing basic system energy resources.
  
• The basis structure, or central core, is made up of the basic survival factors that are common to the species (Neuman,2002).
  
• These factors include:- - Normal temp. range, Genetic structure.- Response pattern. Organ strength or weakness, Ego structure
  
• Stability, or homeostasis, occurs when the amount of energy that is available exceeds that being used by the system.
  
• A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance.
  

Degree to reaction

• the amount of system instability resulting from stressor invasion of the normal LOD.
  

Entropy

• a process of energy depletion and disorganization moving the system toward illness or possible death.
  

Flexible LOD

• It is a protective, accordion like mechanism that surrounds and protects the normal LOD from invasion by stressors.
  

Normal LOD

• It represents what the client has become over time, or the usual state of wellness. It is considered dynamic because it can expand or contract over time. 
  

Line of Resistance-LOR

• The series of concentric circles that surrounds the basic structure.
  
• Protection factors activated when stressors have penetrated the normal LOD, causing a reaction symptomatology. E.g. mobilization of WBC and activation of immune system mechanism
  

Input- output

• The matter, energy, and information exchanged between client and environment that is entering or leaving the system at any point in time.
  

Negentropy

• A process of energy conservation that increase organization and complexity, moving the system toward stability or a higher degree of wellness.
  

Open system

• A system in which there is continuous flow of input and process, output and feedback. It is a system of organized complexity where all elements are in interaction.
  

Prevention as intervention

• Interventions modes for nursing action and determinants for entry of both client and nurse in to health care system.
  

Reconstitution

• The return and maintenance of system stability, following treatment for stressor reaction, which may result in a higher or lower level of wellness.
  

Stability

• A state of balance of harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health thus preserving system integrity.
  

Stressors

• environmental factors, intra (emotion, feeling), inter (role expectation), and extra personal (job or finance pressure) in nature, that have potential for disrupting system stability.
  
• A stressor is any phenomenon that might penetrate both the F and N LOD, resulting either a positive or negative outcome.
  

Wellness/Illness

• Wellness is the condition in which all system parts and subparts are in harmony with the whole system of the client.
• Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002).

PREVENTION

• the primary nursing intervention.
  
• focuses on keeping stressors and the stress response from having a detrimental effect on the body.
  

Primary Prevention

• occurs before the system reacts to a stressor.
• strengthens the person (primary the flexible LOD) to enable him to better deal with stressors
• includes health promotion and maintenance of wellness.

Secondary Prevention

• occurs after the system reacts to a stressor and is provided in terms of existing system.
• focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor.

Tertiary Prevention

• occurs after the system has been treated through secondary prevention strategies.
• offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.

FOUR NURSING PARADIGMS

PERSON

• Human being is a total person as a client system and the person is a layered multidimensional being.
  
• Each layer consists of five person variable or subsystems:
  
• Physiological - Refers of the physicochemical structure and function of the body.
  
• Psychological - Refers to mental processes and emotions.
  
• Socio-cultural - Refers to relationships; and social/cultural expectations and activities.
  
• Spiritual - Refers to the influence of spiritual beliefs.
  
• Developmental - Refers to those processes related to development over the lifespan.
  

ENVIRONMENT

• The environment is seen to be the totality of the internal and external forces (intrapersonal, interpersonal and extra-personal stressors) which surround a person and with which they interact at any given time.
  
• The internal environment exists within the client system.
  
• The external environment exists outside the client system.
  
• The created environment is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness.
  

HEALTH

• Health is equated with wellness.
• “the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman, 1995)”.
• The client system moves toward illness and death when more energy is needed than is available. The client system moved toward wellness when more energy is available than is needed

NURSING

• a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor.
• person is seen as a whole, and it is the task of nursing to address the whole person.
• Neuman defines nursing as “action which assist individuals, families and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient/client system, through nursing interventions to reduce stressors.’’
• The role of the nurse is seen in terms of degree of reaction to stressors, and the use of primary, secondary and tertiary interventions

STAGES OF NURSING PROCESS (BY NEUMAN)

NURSING DIAGNOSIS

• It depends on acquisition of appropriate database; the diagnosis identifies, assesses, classifies, and evaluates the dynamic interaction of the five variables.
  
• Variances from wellness (needs and problems) are determined by correlations and constraints through synthesis of theory and data base.
  
• Broad hypothetical interventions are determined, i.e. maintain flexible line of defense.
  

NURSING GOALS

• These must be negotiated with the patient, and take account of patient’s and nurse’s perceptions of variance from wellness.
  

NURSING OUTCOMES

• Nursing intervention using one or more preventive modes.
  
• Confirmation of prescriptive change or reformulation of nursing goals.
  
• Short term goal outcomes influence determination of intermediate and long – term goals.
  
• A client outcome validates nursing process.
  

Neuman’S SYSTEM MODEL FORMAT

Neuman’s nursing process format designates the following categories of data about the client system as the major areas of assessment.

ASSESSMENT

• Potential and actual stressors.
  
• Condition and strength of basic structure factors and energy sources.
  
• Characteristics of flexible and normal line of defenses, lines of resistance, degree of reaction and potential for reconstitution.
  
• Interaction between client and environment.
  
• Life process and coping factors (past, present and future) actual and potential stressors (internal and external) for optimal wellness external.
  
• Perceptual difference between care giver and the client.
  

NURSING DIAGNOSIS

• The data collected are then interpreted to condition and formulate the Nursing diagnosis.
  
• Health seeking behaviors.
  
• Activity intolerance.
  
• Ineffective coping.
  
• Ineffective thermoregulation.
  

GOAL

• In Neuman’s systems model the goal is to keep the client system stable.
  

PLANNING

• Planning is focused on strengthening the lines of defense and resistance.
  

IMPLEMENTATION

The goal of stabilizing the client system is achieved through three modes of prevention

• Primary prevention : actions taken to retain stability
  
• Secondary prevention : actions taken to attain stability
  
• Tertiary prevention : actions taken to maintain stability
  

EVALUATION

• The nursing process is evaluated to determine whether equilibrium is restored and a steady state maintained.
  

APPLICATION

PRACTICE

• The Neuman systems model has been applied and adapted to various specialties include family therapy, public health, rehabilitation, and hospital nursing.
  

EDUCATION

• The model has also been widely accepted in academic circles.
  
• curriculum guide for a conceptual framework at Indiana University, Northwestern State University in Shreveport, Louisiana.
  

RESEARCH

• A study was published by Riehl and Roy to test the usefulness of the Neuman model in nursing practice.
  

NEUMAN'S SYSTEM MODEL AND THE CHARACTERISTICS OF A THEORY

• Neuman's model connects the  interrelated concepts in such a way as to create a different way of looking at a particular phenomenon.
  
• Neuman’s model in general presents itself as logically consistent.
  

• There is a logical sequence in the process of nursing wherein emphasis on the importance of accurate data assessment is basic to the sequential steps of the nursing process.
  

• Neuman’s model is fairly simple and straightforward in approach.
  
• The terms used are easily identifiable and for the most part have definitions that are broadly accepted.
  

• The model has provided guidelines for nursing education and practice in a variety of settings.
  
• Neuman's model is applicable in the practice as assessment/intervention instrument together with comprehensive guidelines for its use with the nursing process.
  

Research Articles

“Using the Neuman Systems Model for Best Practices’’--Sharon A. DeWan, Pearl N. Ume-Nwagbo, Nursing Science Quarterly, Vol. 19, No. 1, 31-35 (2006).

• The purpose of this study was to present two case studies based upon Neuman systems model; one case is directed toward family care, and the other demonstrates care with an individual. Theory-based exemplars serve as teaching tools for students and practicing nurses.
• These case studies illustrate how nurses' actions, directed by Neuman's wholistic principles, integrate evidence-based practice and generate high quality care  

Melton L, Secrest J, Chien A, Andersen B.    “A community needs assessment for a SANE program using Neuman's model”  J Am Acad Nurse Pract. 2001 Apr;13(4):178-86.

• The purpose of the study was to present guidelines for a community needs assessment for a Sexual Assault Nurse Examiner (SANE) program using Neuman's Systems Model.  
• Sexual assault is a problem faced by almost every community. A thorough community assessment is an important first step in establishing programs that adequately meet a community's needs.
• Guidelines for conducting such an assessment related to implementation of a SANE program are rare, and guidelines using a nursing model were not found in the literature

REFERENCES

1. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, NY.
   
2. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange.
   
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
   
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott.
   
5. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.
   
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.
   
7. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
   
8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225
   
9. Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd edition, Thomson, NY, 2002