Nursing Files
Theories
Betty Neuman Systems Model
INTRODUCTION
- Theorist
- Betty Neuman - 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
- Theory
was published in:
- “A
Model for Teaching Total Person Approach to Patient Problems” in Nursing
Research - 1972.
- "Conceptual
Models for Nursing Practice", first edition in 1974, and second
edition in 1980.
- Betty
Neuman’s system model provides a comprehensive flexible holistic and
system based perspective for nursing.
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 differs in its
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 (Neuman, 2002)
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
basic structure, or central core, is made up of the basic survival factors
which 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
- 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.
- 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.
- 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
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.
NEUMAN'S MODEL
& CHRACTERISTICS
- interrelated
concepts
- logically
consistent.
- logical
sequence
- fairly
simple and straightforward in approach.
- easily
identifiable definitions
- provided
guidelines for nursing education and practice
- applicable
in the practice
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).
- 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.
CONCLUSION
- Betty
Neuman’s system model provides a comprehensive flexible holistic and
system based perspective for nursing.
- Neuman's
model 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.
REFERENCES
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- George
B. Julia , Nursing Theories- The base for professional Nursing Practice ,
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- Wills
M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing
Philadelphia. Lippincott Williams& wilkins.
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Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd
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- Taylor
Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th
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- Potter
A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process
& Practice 3rd ed. London Mosby Year Book.
- Vandemark
L.M. Awareness of self & expanding consciousness: using Nursing
theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) :
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- Reed
PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006
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standard and practice, 2nd edition, Thomson, NY, 2002.