Betty Neuman's System Model This page was last updated on November 9, 2010 =============================================== INTRODUCTION Betty Neuman’s system model provides a comprehensive flexible holistic and system based perspective for nursing. It focuses attention 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. She completed BS in nursing in 1957 and MS in Mental Health Public health consultation, from UCLA in 1966. She holds a Ph.D. in clinical psychology She was a pioneer in the community mental health movement in the late 1960s. Betty Neuman began developing her health system model while a lecturer in community health nursing at University of California, Los Angeles. 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. The model was published in 1972 as “A Model for Teaching Total Person Approach to Patient Problems” in Nursing Research. It was refined and subsequently 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 a variety of sources. The philosophy writers deChardin and cornu (on wholeness in system).
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B e t t y N e u m a n ' s S y s t e m M o d e lThis page was last updated on November 9, 2010
===============================================
INTRODUCTION
Betty Neuman’s system model provides a comprehensive flexible
holistic and system based perspective for nursing.
It focuses attention 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.
She completed BS in nursing in 1957 and MS in Mental Health
Public health consultation, from UCLA in 1966. She holds a Ph.D. in
clinical psychology
She was a pioneer in the community mental health movement in the
late 1960s.
Betty Neuman began developing her health system model while a
lecturer in community health nursing at University of California, Los
Angeles.
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.
The model was published in 1972 as “A Model for Teaching Total
Person Approach to Patient Problems” in Nursing Research.
It was refined and subsequently 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 a variety of sources.
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
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.
CONCEPTS
Content: - the variables of the person in interaction with the internal
and external environment comprise the whole client system
Basic structure/Central core: - 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: - 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.
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.
o Illness is a state of insufficiency with disrupting needs
unsatisfied (Neuman, 2002).
o Illness is an excessive expenditure of energy… when more
energy is used by the system in its state of disorganization
than is built and stored; the outcome may be death
(Neuman, 2002).
PREVENTION
According to Neuman’s model, prevention is the primary nursing
intervention. Prevention focuses on keeping stressors and the stress
response from having a detrimental effect on the body.
PRIMARY PREVENTION
Primary prevention occurs before the system reacts to a stressor.
On the one hand, it strengthens the person (primary the flexible
LOD) to enable him to better deal with stressors
On the other hand manipulates the environment to reduce or
weaken stressors.
Primary prevention includes health promotion and maintenance of
wellness.
SECONDARY PREVENTION
Secondary prevention occurs after the system reacts to a stressor
and is provided in terms of existing system.
Secondary prevention focuses on preventing damage to the central
core by strengthening the internal lines of resistance and/or
removing the stressor.
TERTIARY PREVENTION
Tertiary prevention occurs after the system has been treated
through secondary prevention strategies.
Tertiary prevention offers support to the client and attempts to add
energy to the system or reduce energy needed in order to facilitate
reconstitution.
FOUR MAJOR CONCEPTS
PERSON
The focus of the Neuman model is based on the philosophy that
each 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:
o Physiological- Refer of the physicochemical structure and
function of the body.
o Psychological- Refers to mental processes and emotions.
o Socio-cultural- Refers to relationships; and social/cultural
expectations and activities.
o Spiritual- Refers to the influence of spiritual beliefs.
o 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 which surround a person and with which they interact
at any given time.
These forces include the intrapersonal, interpersonal and extra-
personal stressors which can affect the person’s normal line of
defense and so can affect the stability of the system.
o The internal environment exists within the client system.
o The external environment exists outside the client
system.
o Neuman also identified a created environment which is
an environment that is created and developed
unconsciously by the client and is symbolic of system
wholeness.
HEALTH
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)”.
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
Neuman sees nursing as a unique profession that is concerned with
all of the variables which influence the response a person might
have to a stressor.
The 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.’’
Neuman states that, because the nurse’s perception will influence
the care given, then not only must the patient/client’s perception be
assessed, but so must those of the caregiver (nurse).
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.
ACCEPTANCE BY THE NURSING COMMUNITY
Neuman’s model has been described as a grand nursing theory by
walker and Avant.
Grand theories can provide a comprehensive perspective for nursing
practice, education, and research and Neuman’s model does.
PRACTICE
The Neuman systems model has been applied and adapted to
various specialties include family therapy, public health,
rehabilitation, and hospital nursing.
The sub specialties include pulmonary, renal, critical care, and
hospital medical units. One of the model’s strengths is that it can be
used in a variety of settings
Using this conceptual model permits comparison of a nurse’s
interpretation of a problem with that of the patient, so the patient and
nurse do not work on two separate problems.
The role of the nurse in the model is to work with the patient to move
him as far as possible along a continuum toward wellness.
Because this model requires individual interaction with the total
health care system, it is indicative of the futuristic direction the
nursing profession is taking.
The patient is being relabeled as a consumer with individual needs
and wants.
EDUCATION
The model has also been widely accepted in academic circles.
It has often been selected as a curriculum guide for a conceptual
framework oriented more toward wellness than toward a medical
model and has been used at various levels of nursing education.
In the associate degree program at Indiana University.
One of the objectives for nursing graduate is to demonstrate ability
to use the Neuman health care system in nursing practice. This
helps prepare the students for developing a frame of reference
centered on holistic care.
At northwestern State University in Shreveport, Louisiana, the
faculty determined that a systems model approach was preferred for
their master’s program because of the universality framework.
Acceptance by the nursing community for education therefore is
evident.
RESEARCH
A study was published by Riehl and Roy to test the usefulness of the
Neuman model in nursing practice.
There were two major objectives of the study.
o To test the model/assessment’ tool for its usefulness as a
unifying method of collecting and analyzing data for
identifying client problems.
o To test the assessment tool for its usefulness in the
identification of congruence between the client’s
perception of stressors and the care giver’s perception of
client stressors.
Results indicated that the model can help categorize data for
assessing and planning care and for guiding decision making.
Neuman’s model can easily generate nursing research.
It does this by providing a framework to develop goals for desired
outcomes. Acceptance by the nursing community for research
applying this model is in the beginning stages and positive.
Neuman’S AND THE CHARACTERISTICS OF A THEORY
Theories connects the interrelated concepts in such a way as
to create a different way of looking at a particular phenomenon.
The Neuman model represents a focus on nursing interest in the
total person approach to the interaction of environment and health.
The interrelationships between the concepts of person, health,
nursing and society/environment are repeatedly mentioned
throughout the Neuman model and are considered to be basically
adequate according to the criteria.
Theories must be logical in nature
o Neuman’s model in general presents itself as logically
consistent.
o 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.
Theories should be relatively simple yet generalizable.
o Neuman’s model is fairly simple and straightforward in
approach.
o The terms used are easily identifiable and for the most part
have definitions that are broadly accepted.
o The multiple use of the model in varied nursing situations
(practice, curriculum, and administration) is testimony in
itself to its broad applicability.
o The potential use of this model by other health care
disciplines also attests to its generalizability for use ion
practice.
o One drawback in relation to simplicity is the diagrammed
model since it presents over 35 variables and tends to be
awesome to the viewer.
Theories can be the bases for hypotheses that can be tested.
o Neuman’s model, due to its high level and breadth of
abstraction, lends itself to theory development.
o One are for future consideration as a beginning testable
theory might be the concept of prevention as intervention,
subsequent to basis concept refinement in the Neuman
model.
Theories contribute to and assist in increasing the general
body of knowledge within the discipline through the research
implemented to validate them.
o The model has provided clear, comprehensive guidelines
for nursing education and practice in a variety of settings;
this is its primary contribution to nursing knowledge.
o The concept within the guidelines is clearly explicated and
many applications of the theory have been published, little
research explicitly derived from this model has been
published to date.
Theories can be utilized by the practitioner to guide and
improve their practice.
o One of the most significant attributes of the Neuman model
is the assessment/intervention instrument together with
comprehensive guidelines for its use with the nursing
process.
o These guidelines have provided a practical resource for
many nursing practitioners and have been used
extensively in a variety of setting in nursing practice,
education and administration.
Theories must be consistent with other validated theories, laws
and principles but will leave open unanswered questions that
need to be investigated.
o In general, there is no direct conflict with other theories.
There is, however, a lack of specificity in systems concepts
such as “boundaries” which are indirectly addressed
throughout the model.
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).
o 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.
o 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.
o 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.
o 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.
o 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
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