Nursing Theorist Betty Neuman, PhD, RN, FAAN Vinitha Manuel Rebekkah McConnell Wendy Szymoniak Ericca Whitlow

Why The Neuman Systems Model? “The Neuman Systems Model is well positioned as a directive for a truly wholistic perspective for nursing. Its concepts and processes are relevant for the twenty-first century and beyond. Its universal and timeless nature has long proven its value in being utilized effectively by health care professionals in any cultural setting” (Alligood & Tomey, 2010).

Focusing on the nursing model of Betty Neuman, PhD, RN, FAAN Delivers different aspects that are affecting to a client’s health condition Assists nurses in providing care using a holistic approach Focuses on the nursing process: assessment, diagnosis, intervention, evaluation Focuses on client related stressors: how to diagnose, treat, and manage stress

The Neuman System’s Model The Neuman Systems Model requires the care of the patient to be comprehensive. Nurse's should consider more than the surgical intervention the patient has undergone in addition to looking at the patients overall concept of their illness and their environment. I believe this models allows me to best see the whole of the person I am treating; increasing my critical thinking skills in relation to the larger picture and not a single diagnosis.

The Neuman System’s Model

Historical Background This model was developed because nursing graduates felt they needed to be exposed to course content that would give them a variety of general nursing problems prior to focusing on specific nursing problems. It was first published in 1972 as A Model for Teaching Total Person Appropriate Patient Problems later published in the first edition of Conceptual Models for Nursing Practice in 1974 and then refined to second edition in 1980 (Alligood & Tomey, 2010).

Philosophic values: Nursing and knowledge development The Neuman System’s Model reflects wellness and illness in people that are approached “wholistically” to provide a “unifying focus” that will assist nurses in understanding the client through interaction with the perceived or actual environmental stressors in order to prevent illness or to intervene and implement appropriate goals post illness and/or injury (Alligood & Tomey, 2010).

Influenced: Author’s Philosophy Betty Neuman developed The System’s Model by incorporating from several other theorist not limited to Lararus, Selyl, Von Barlatanfy(1968), and from the Gestalt Theory (Pearls 1973) (Alligood & Tomey, 2010). Also, drawing from her own beliefs and clinical nursing experiences, she has obtained a bachelors degree in public health and psychology in 1957, her MS in mental health, public health consultation in 1966, and doctoral degree in clinical psychology in 1985. Her mental health nursing experience was the most influential to her theory (Alligood & Tomey, 2010).

Four Global Concepts Human Being Environment Health Nursing (Alligood&Tomey, 2010)

Nursing Metaparadigm: Human Being Believes client may be an individual, family, group, community, social issue Composes interrelationships: physiological, psychological, sociocultural, developmental, and spiritual factors

Nursing Metaparadogm: Human Being (cont.) The layers, usually represented by concentric circle, consist of the central core, lines of resistance, lines of normal defense, and lines of flexible defense. The basic core structure is comprised of survival mechanisms including: organ function, temperature control, genetic structure, response patterns, ego, and what Neuman terms known and commonalities. Lines of resistance and two lines of defense protect this core. Around the basic core structures are lines of defense and resistance (Hayman, 2000)

Environment: Internal & external factors Correlated with the interpersonal factors and is a stressor that is contained completely within the client or client system External Consists of all the stressors that exist outside the client but affect the well being and health of the client or client system

Environment (cont.) 3 environments Internal: Interpersonal-all interactions contained within the client External: Interpersonal & extra personal- outside the client Created: Intrapersonal-unconsciously developed; supports protective coping influenced by changes in clients state of wellness

Health Wellness Model Dynamic in nature and constantly changing Optimal wellness or stability indicates that total system needs are being met. A reduced state of wellness is a results of unmet systemic needs

Health (cont.) Neuman sees health as being equated with wellness. She defines health/wellness as "the condition in which all parts and subparts (variables) are in harmony with the whole of the client” (Neuman, 1995). As the person is in a constant interaction with the environment, the state of wellness (and by implication any other state) is in dynamic equilibrium, rather than in any kind of steady state. Neuman proposes a wellness-illness continuum, with the person's position on that continuum being influenced by their interaction with the variables and the stressors they encounter. The client system moves toward illness and death when more energy is needed than is available. The client system moves toward wellness when more energy is available than is needed.

Nursing Nursing is a holistic approach (caring for the patient as a whole). They respond to stressors and are the advocate for the patents, in which the nurses need to addresses the stressors. Views nursing as a “unique profession that it is concerned with all of the variables affecting an individuals response to stress” (Alligood & Tomey, 2010).

Nursing (cont.) “Neuman defines nursing as actions 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” (Hayman, 2000).

Clarification of Origins “The Neuman Health Care Systems model originated as a result of the need to develop a broad-based conceptual framework of curriculum design, providing unity, integration and co-ordination of the nursing course content”(Parr,1993). The idea behind this model is that nursing is about the total person and it is an inimitable profession that is apprehensive about the variable affecting and person in response to stress. This model is about a total person’s attitude and it is focused on bringing together an effort to different nursing problems and for understanding man and his environment. “It takes an open system approach, a system that is never at rest because it is always trying to maintain homeostasis among stressors” (Parr,1993). The models was initially developed in response to graduate nursing students expression of a need for course content that would expose them to breadth of nursing problems prior to focusing on specific nursing problem areas.

Is this philosophy unique to nursing? This philosophy provides a broad adaptable holistic and system based point of view for nursing The main focuses on client system to actual or potential environmental stressors and the use of preventive measures, such as primary, secondary and tertiary prevention and their intervention for maintaining the clients optimal system wellness

Neuman’s Model: Primary Prevention Used when stressors are suspected or recognized Purpose: decrease the stressor and/or decrease the reaction (Alligood & Tomey, 2010)

Nueman’s Model: Secondary Prevention Includes interventions or treated after symptoms from the stressor(s) have arose Client’s internal and external strengthen Reduces the reaction Increases resistance factors (Alligood & Tomey, 2010)

Neman’s Model: Tertiary Prevention Occurs after treatment or secondary prevention stage Focuses on modification for client system stability Maintains wellness; prevention of reoccurrence Avoiding stressors that the client recognizes as being harmful (Alligood & Tomey, 2010)

Neuman’s Model: Reconstitution Occurs after treatment for stressor reactions Maintains system strength which in turn advances or worsens the wellness before the stressor is involved (Alligood & Tomey, 2010)

What or who influenced this model? The philosophy of writers such as deChardin Pierre Tielhard deChardin was a priest and a scientist who came up with spiritual evolution. He believed in the idea that the humans are more spiritually growing into an ultimate excellence called Omega Point. He is most often associated with the idea of a mind mesh, the interconnectedness of human spirit and mind, similar to Carl Jung's collective unconscious. Gestalt theory Hans Selye's Gestalt Theory is a theory of German origin that is about the concept of whole. Its underlines the primacy of phenomena (the perceived), asserting that the human world of experience is the only immediately given reality. The collaboration of the individual and the situation controls the experience and behavior (meaning that no two interactions will ever be the same and we should not simplistically over generalize) (Hayman, 2000).

What or who influenced this model? (cont.) General Adaptation Syndrome The General Adaptation Syndrome is universal and it is taught in health classes in high school. It suggests that there is a common response to stress. First is the alarm stage, then the resistance stage and the third is the exhaustion stage. In alarm stage the body starts to prepare to deal with the stressor. The resistance stage, the body likes to be in homeostasis or resting state, the body work hard to become normal. Then last is the exhaustion stage where the body gets tired and collapse. General Systems Theory This theory talks about the thermodynamics which is part of physics, chemistry and engineering. Thermodynamics is the study of the flow of energy from one system to another. It is about the world is like the thermodynamics which is there is a flow of energy from one thing to another and they are interconnected and influenced by each other to function in a high organized manner. If there is something not functioning then the whole system will fail.

Narrow View? This model may be used anywhere in a clinical setting. Ways of using this model include nursing processes such as assessment, nursing diagnosis, outcome, implementation, and evaluation. According to currentnursing.com, this model may be used: To assess the patient condition by the various methods explained by the nursing theory To identify the needs of the patient To demonstrate an effective communication and interaction with the patient. To select a theory for the application according to the need of the patient To apply the theory to solve the identified problems of the patient To evaluate the extent to which the process was fruitful (“Betty neuman”, 2011)

Neuman and Koertvelyessy Generated two theories from this model The theory: Optimal client system stability The theory: Prevention as intervention (Alligood & Tomey, 2010) Use of the model develops middle range theory research based on practice “Further research is needed to validate the relationship between models concepts and research outcomes” (Alligood & Tomey, 2010)

Critique Neumans model provides nurses and other healthcare professionals a wide range of creativity in it’s use; past, present, and future. Clarity Simplicity Generality Empirical Precision Derivable Consequences Application in Practice (Alligood & Tomey, 2010)

Clarity The models clarity was criticized in that its concepts needed to be defined more completely (Alligood & Tomey, 2010)

Simplicity Complex in nature-can not be described as simple framework Nurses using the model describe it as “easy to understand and use across cultures and in a wide variety of practice settings” (Alligood & Tomey, 2010).

Generality Comprehensive and adaptable Concepts are: Broad and represent the phenomenon of the client Definitive Identify modes of actions (four preventions) (Alligood & Tomey, 2010)

Empirical Precision The Research Institute and nurse researchers plan to increase the empirical precision as research continues and findings from multiple studies are created (Alligood & Tomey, 2010)

Derivable Consequences Guidelines for the nurse for assessment of the client system Utilization of the nursing process Implementation of preventive interventions The potential of generating nursing theories (i.e. theories of optimal client stability and prevention as intervention) (Alligood & Tomey, 2010)

Application in Practice Interdisciplinary practice Social workers Physical therapy Acute care psychiatric patients Public health facilities Adolescent drug rehabilitation centers Hospital settings Individuals, families, groups, communities Various countries other than the USA

Case Study Mrs. Loder is a 42 year old woman currently hospitalized for new onset of seizure disorder after experiencing a headache for three days. She has stable, long term full time employment in a managerial position. She takes no current medications, is physically active and has an outgoing personality. She and her husband have lived within their current neighborhood for more than 20 years and describe their involvement in the community as very important. . Her only prior involvement with the health care system was the birth of her son twelve years ago. Within three days of admission to the hospital Mrs. Loder is diagnosed with multiforme glioblastoma and undergoes a craniotomy to debulk the tumor. She requires very little pain medication and has had no further seizure activity. Medications include Keppra and Decadron which she will continue to take after discharge. She will have continued treatment including chemotherapy, radiation and eventual further debulking of her tumor. She and her husband plan to return home at discharge. Mr. Loder will need to return to work as soon as possible. They state they are determined to remain positive in their thinking and they have not informed their son of the extent of the illness. The Loder’s do not have family locally but there have been multiple offers of community support. They have declined home health nursing at this time. Neuman feels that nurses are unique in that they treat the entire client system and they will widen their focus of care to include all of the variables that will affect the client’s response to current stressors they are experiencing. The nurse’s perception of the client’s situation will affect the care that they will provide (Neuman, 2002).

Case Study Questions 1. How would the Loder family be described in the client system? 2. What is the environment of the client and how will it affect long term functioning 3. What interventions would the nurse best fit into place to help the client system maintain the greatest possible stability?

Answers: Case Study Questions 1. How would the Loder family be described in the client system? A. The Loder family will be in the midst of a new experience. This experience will affect all aspects of their lives and will have personal, financial, and interpersonal stressors. There appears to be a close and supportive interpersonal relationship that will be ongoing. Mrs. Loder is the primary wage earner and there will be a significant financial strain placed on the family. Extended family is not currently available. There will be a requirement for current and ongoing health care intervention which is new for this family. Mrs. Loder may or may not want to continue working, as possible. Nursing will need to understand their role in providing support and referrals to other disciplines based on the family needs.

Answers: Case Study Questions 2. What is the environment of the client and how will it affect long term functioning? A.The environment of this client system is multifactorial. The family will be experiencing change in the normal social routine and personal interactions. There will be a large support group of friends, coworkers and neighbors. This is positive because there will be many needs to be met in the coming months and the family will be able to function independently but also able to call on the help of others as needed. The negative aspect of their environment may be the initial overwhelming need of others to be involved or help when the family is still in the phase of learning to work through the new diagnosis and the lifestyle choices they will make during changes in Mrs. Loders health status.

Answers: Case Study Questions 3. What interventions would the nurse best fit into place to help the client system maintain the greatest possible stability? A. Nursing should meet the requirement of immediate care by providing information about resources the patient and family may need in the current timeframe. Referrals should be made to initiate social work availability. Nursing can help to delineate the current necessary stressors and the interpersonal stressors which can be addressed by community nursing and support groups available to the patient and her family that will be needed in the future.

References Betty Neuman's systems model. (2011, February 21). Retrieved from http://currentnursing.com/nursing_theory/Neuman.html Hayman, P., & Wolfe, S. (2000, April). Neuman system model. In Neuman System Model. Retrieved March 27, 2011, from http://www.patheyman.com/essays/neuman/index.htm Neuman, B. (1995). The Neuman systems model (3rd ed.). Norwalk, CT: Appleton & Lange. Neuman, B., & Fawcett J. (2002). The Neuman systems model (4th ed.). Upper Saddle River, NJ: Prentice Hall. Parr, M. (1993). The Neuman Health Care Systems model-an evaluation. British Journal of Theatre Nursing, 3(8), 20-27. Alligood, M., & Tomey, A. (2010). Nursing theorists and their work (4th ed.). Maryland Heights, MO: Mosby.