Transcript Neuman system model - Rebekkah McConnell, RN

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
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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
 Internal
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 personaloutside 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


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“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
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
Concepts
and adaptable
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.
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