NEUMAN SYSTEMS MODEL.ppt

This system model provides a comprehensive, flexible, holistic and system based perspective for nursing.
It deals with stress and stress reduction and is primarily concerned with the effects of stress on health.
This model provides a total approach to client problems by providing a multidimensional view of the person as an individual.

1. SYSTEMS MODEL
BETTY NEUMAN

2. BETTY NEUMAN
Briefintroduction
•Bornin1924inOhio.
•Diploma–1947,fromPeople’shospital,Ohio
•B.S.inpublichealthnursing–1957
•M.S.aspublichealth-mentalhealthnurseconsultant-1966,
California
•Honorarydoctorates

3. INTRODUCTION CONTD…
•DoctorateinclinicalpsychologyfromPacificWestern
University-1985
•MultipleHonorarydoctorate
ContributionAreas:
•Publichealth,hospital,schoolhealth,industryandmental
healthsettings.

4. Neuman’sSystem MODEL

5. Fig. 1 The Neuman system model (original diagram copyright1970 by betty neuman

6. THE NEUMAN SYSTEMS
MODEL
•Providesacomprehensive,flexible,holisticandsystem
basedperspectivefornursing.
•Dealswithstressandstressreductionandisprimarily
concernedwiththeeffectsofstressonhealth.
•Accordingtoher,thismodelprovidesatotalapproach
toclientproblemsbyprovidingamultidimensional
viewofthepersonasanindividual.

7. Fig 1. Core and concentric circles
Flexible line of
defense
Normal line of
defense
Basic structure/
Core
Line of
resistance

8. FLEXIBLE LINE
OF DEFENSE
•Outerboundary
•Initialresponseorprotective
barriertopreventstressorsfrom
breakingthroughthenormalline
ofdefense.
•Cushion
•Dynamic
•AsdistancebetweenFLODand
NLODincreases,sodoesthe
degreeofprotection.
•Affectedbyvariablessuchas
lossofsleep,inadequate
nutrition;thatreducetheclient's
abilitytouseaflexiblelineof
defenseagainststressors.

9. •Representsstabilityovertimeor
normalwellnessstate.
•Anystressorsmayinvadethe
NLOD whenFLOD offers
inadequateprotection.
•WhenNLODisinvadedtheclient
systemreacts.
•Reactionswillbeapparentin
symptomsofinstabilityorillness.
NORMAL LINE
OF DEFENSE

10. LINES OF
RESISTANCE
•Protectsthebasicstructure.
•BecomesactivatedwhenNLODisinvaded
byenvironmentalstressors.
•Fore.g.:activationofimmunesystem
mechanisms.
•IfLORiseffective,systemcan
reconstitute.
•Ifnoteffective,theresultingenergy
depletionmayleadtodeath.

11. THE BASIC CORE STRUCTURE
•Madeupofthebasicsurvivalfactorsthatare
commontothespecies(Neuman,2002).
•Includes:normaltemperaturerange,genetic
structure,responsepattern,organstrengthor
weakness,egostructure.

12. CLIENT VARIABLES
•Eachconcentriccircleorlayerismadeupofthefivevariable
areaswhichoccursimultaneouslyineachclient:
•Physiologicvariables
•Psychologicalvariables
•Socio-culturalvariables
•Developmentalvariables
•Spiritualvariables-addedin1989

13. CLIENT VARIABLES contd…
•In ideal situation these variables function in harmony.
•Eachofthevariablesshouldbeconsideredwhenassessing
systemreactionstostressorsforeachoftheconcentriccircles
inthemodeldiagram.

14. NURSING INTERVENTIONS
•Focusonretainingormaintainingsystemstability.
•Arecarriedoutonthreepreventivelevels.
Primarypreventionasintervention
Secondarypreventionasintervention
Tertiarypreventionasintervention

15. METAPARADIGM
Human being
Is viewed as an open system that interacts with both internal and
external environmental forces and
stressors.
The human is in constant change, moving towards a dynamic
state of system stability or towards illness of varying degrees.

16. ENVIRONMENT
Theenvironmentmaybeviewedasallfactorsthataffectand
affectedbythesystem.Itincludesinterpersonal,intrapersonaland
extra-personalstressorsthatinterferewithperson'snormallineof
defenseandcanaffectthesystem'sstability.

17. HEALTH
Definedasconditionordegreeofsystemstability
andisviewedasacontinuumfromwellnesstoillness.
Stabilityoccurswhenallsystem'spartsandsubpartsareinbalance
orharmonysothatthe
wholesystemisinbalance.

18. WELLNESS ILLNESS CONTINUM
Wellness : More energy available and
stored than expended
Towards increasing wellness
Interventions
(Disrupting forces
or stressors)
Death: More energy needed
than is available to support life
Towards increasing illness

19. NURSING
Asactionsthatassistpersons,familiesandgroupstoattainand
maintainamaximumlevelofwellness.
Nursingusesprimary,secondaryandtertiaryinterventionsto
reduceclient'sstressors.Itconsistofthreesteps:Nursing
diagnosis,nursinggoalsandnursingoutcomes.

20. Application of Neuman
system Model in clinical
practice

21. NeumanSystemModelNursingProcess
Format
Neumanpresentsa3stepnursing
processformat,knownastheNeuman
SystemModelNursingProcessFormat.
NursingDiagnosis(assessmentanddiagnosis)
NursingGoals(planandexpectedoutcomes)
NursingOutcomes(implementationand
evaluation)

22. NursingDiagnosis
Toidentifyvariancesfromwellnessanddevelopmentof
hypotheticalinterventions
Nursesfocusonobtainingdataofclientwithregards:
Todeterminetheexistingstateofwellness
(Assessmentofbasicstructure,FLOD,NLOD,LOR)
Identify,classifyandevaluateactualandpotentialstressors
(intra,interandextrapersonalinteractioninallfivevariables)
Identify,classifyandevaluatetheactualorpotentialreactionto
environmentalstressors.
Evaluatetheinfluenceofpast,presentandfuturecopingpatterns.
Forthisuseassessmentandinterventiontool.

23. An assessment and
interventiontool
1.Intakesummary
Name,Age,Sex,MaritalStatus,referralsourceand
relatedinformation
2.Stressorsasperceivedbyclients
Majorstressareaofhealthconcerns
lifestylepatterns
pastcopingpatterns
anticipatingoneselfinthefutureasaconsequencesof
presentsituation
activitiesdoingtohelponeselfnowandwhatcanyoudo
expectationofactivitiesforoneselffromcaregivers,family,
friends

24. Contd..3.Stressorsasperceivedbycaregiver
Majorstressareaofhealthforclient
differenceofclientpresentandusualpatternofliving
clientpastcopingpatterns
anticipatingclientinthefutureasaconsequencesofpresent
situation
activitiesofclienttohelphimself
andexpectationofclient(activities)fromcaregivers,family,
friends
Summaryofimpression
Noteanydiscrepanciesordistortionbetweenthe
client’sperceptionandthatofthecaregiverasrelates
tothesituation.

25. Contd..
4.Intrapersonalfactors
i.Physical
ii.Psychological
iii.Sociocultural
iv.Developmental
v.Spiritual
5.Interpersonalfactors-resourcesandrelationshipsof
family,friendsorcaregiversthateitherinfluenceor
couldinfluencearea4.
6.Extrapersonalfactors-resourcesandrelationshipsof
communityfacilities,finances,employmentorother
areathateitherinfluenceorcouldinfluencearea4and
5.
Overallsummary
Physiological,Pshyological,Sociocultural,DevelopmentalandSpiritual

26. Contd…
7.Formulationofacomprehensive
NursingDiagnosis
Identifyingandrankingthepriorityof
needsbasedontotaldataobtainedfrom
:
theclient’sperception
thecaregiversperception
orotherresourcessuchaslaboratoryreports,
othercaregiversoragencies.

27. NursingGoal
Interventionstrategiesnegotiatedwith
clienttoretain,attainandmaintain
client/clientsystemstability.
Outcomesarespecifiedunderitasgoal
outcometocorrectvariances.

28. Nursingoutcomes
Beginwithnursinginterventioni.e.3levelsofprevention-as-intervention
andthatmaybeusingoneormore.
Thesenursinginterventions-as-preventionarefollowedbyevaluationto
confirmthattheanticipatedorprescribedchangehasoccurred.
Ifthisisnottrue,thengoalsarereformulated.
long-rangegoalsarethenstructuredinrelationtotheshort-range
outcomes.
Outputvalidatesnursingprocessandactsasfeedbacktofurthersystem
inputasrequired.

29. Primary
prevention
•Covert or potential
stressor
•Potential reaction
based on available
knowledge
•Prevent stressor
invasion by
strengthening FLOD.
•Education and
desensitization to
stressors.
•Use stress as a
positive intervention
strategy.
Secondary
prevention
•Overt or actual
stressors
•Identify symptoms
•Protect basic structure
following invasion.
•Motivate, educate and
involve client in health
care goals.
•Provide primary
prevention strategy as
required.
Tertiary prevention
•Overt
•Potential reaction
based on symptoms
•During reconstitution,
attain and maintain
stability.
•Coordinate and
integrate health
service resources.
•Provide primary
and/or secondary
prevention
intervention as
required.

30. APPLICATION IN
EDUCATION, RESEARCH AND
PRACTICE

31. InEducation
•1980s--explorationanduseofthemodelgreatly
acceleratedineducationatalllevelsofpracticein
variedsettings.
•Manyschoolsofnursingintheworld(usa,canada,
australia,india,nepaletc.)usetheNeumanSystems
Modelasacurriculumframeworkorforselected
courses.
•B.sc.NursingcourseofNepalincorporatethismodel
inthecurriculum.

32. Inresearch
•Inordertofacilitatetheuseofnursingresearchwith
theNeumanSystemsModel,Fawcetthasoffered
guidelinesforconstructingNeumanSystems
Model–basedstudies.
•Neumanmodelhasguidedarangeofstudy
designs,fromqualitativedescriptionsofrelevant
phenomenatoquantitativeexperimentsthattested
theeffectsofpreventioninterventionsonavariety
ofclient-systemoutcomes

33. Inpractice
•Usedindifferentsettings
•Usedtoguidepracticewithclientswith
cognitiveimpairments,meetingthefamily
needsofclientsincriticalcare,toprovide
stablesupportgroupsforparentswithinfants
inNICUandtomeettheneedsofhome
caregivers,withemphasisonclientswith
cancer,HIV/AIDS,andheadtraumas.

34. STRENGTHS
AND
LIMITATIONS

35. STRENGTHS
•Therelationshipamongconceptsarelogicallyandclearly
defined.
•Fairlysimpleandstraightforwardinapproach.
•Easilyidentifiabledefinitions
•Theholisticsystemapproachused;indicatesthemodelisnot
situationspecificbutmaybeusedinavarietyofsituations.

36. STRENGTHS contd..
•Providescleardirectionforinterventionsthroughprimary,
secondary,andtertiarypreventionwhichhavegaineduniversal
acceptance.
•Provideimportantguidelinesfornursingresearch,education
andpractice.

37. LIMITATIONS
•Someconceptslikelevelofwellness,andconceptof
reconstitutionrequiresclearerdefinitionandfurther
explanations.
•Componentsoftheflexiblelineofdefenseinteractin
verycomplexwaysanditmaybedifficultto
overgeneralizetheirinteraction.
•Althoughreactionisidentifiedinthepictorialmodel,itisnot
discussedseparately.

38. References
Adhikari, R. D. (2010). Nursing theories and modules (2
nd
ed).
Makalu Publication House: Dillibazar, Kathmandu.
George, J. B. (2011). Nursing theories: the base for professional
nursing practice (6
th
ed).Pearson, India
Rai, L. (2011). Nursing Concepts Theories and Principles(2nd edition
ed.). Udayapur: NabinKumar Rai.
Raj, D. E. (2011). Nursing Theories A practical View.New Delhi:
JaypeeBrothers Medical Publisher (Pvt.) Ltd.

39. THANK YOU