The Betty Neuman theory - Easy to understand ,The Neuman Systems Model

Nursing Theory is defined as " A creative and rigorous structuring of Ideas, that project Tentative, Purposeful, and Systematic view of Phenomena." Aims of Nursing theories including to Describe, Predict, and Explain the Phenomenon of Nursing (Chinn and Jacobs, 1978).Main categories of Nursing theories are Grand Theory, Middle Range Theory, and Practice level Theory.

1. Prepared By, Ms.Chithra.A.Valsan I Year Msc Nursing THE NEUMAN SYSTEMS MODEL : BETTY NEUMAN

2. INTRODUCTION Betty Neuman was born in 1924 in Ohio. Graduation  Peoples hospital, SON in Ohio in1947. Baccalaureate degree in public health and psychology in 1957. M.sc in mental health, public health consultation in 1966 from University of California –Los Angeles. Doctoral degree in clinical psychology at Pacific Western University in 1985.

3. INTRODUCTION (cont’d…) The Neuman system model is based on the general systems theory. Neuman synthesized knowledge from several disciplines, incorporating her own philosophical beliefs and clinical nursing expertise. For eg : the model draws from gestalt theory descriptions of homeostasis, Selye’s definitions of stress, etc.

4. OVERVIEW OF THE NEUMAN SYSTEM MODEL

5. OVERVIEW OF THE NEUMAN SYSTEM MODEL According to Neuman , “The Neuman system model is the unique system based perspectives that provides a unifying focus for approaching a wide range of nursing concerns.” In this model, the client system in interaction with the environment is the domain of nursing concern. The client system can be defined as a single client, a group, a number of groups, or a social issue.

6. OVERVIEW (cont’d…) This model is a wellness model based on the general system theory in which the client system is exposed to the environment stressors from within and without the system. The focus is on the client system in relationship to the environmental stressors. The client system is protected by a circular series of buffers known as lines of defense that minimize the effects of stressors.

7. OVERVIEW (cont’d…) Progressing inward, 3 lines of defense are encountered, the flexible line of defense, the normal line of defense, and lines of resistance. The greater quality of the client system’s health, the greater the levels of protection provided by the various lines of defense.

8. CENTRAL CORE The central core structure consists of basic survival factors (normal temperature, genetic structure, response pattern, organ strength /weakness , ego structure) That are surrounded by : Several lines of resistance The normal line of defense The flexible line of defense

9. LINES OF RESISTANCE A protective mechanism that attempts to stabilize the client system and foster a return to the usual wellness. Lines of resistance certain known and unknown internal and external resource factors that support client’s basic structure.

10. NORMAL LINE OF DEFENSE The client / client system normal or usual wellness level. This line represents what the client has become evolved over time. This normal d efense line is the standard against determining any variance from wellness.

11. FLEXIBLE LINE OF DEFENSE Forms the outer boundary of the defined client system. Act as a protective buffer system for the client’s normal line of defense or wellness state.

12. METAPARADIGM CONCEPTS AS DEFINED IN NEUMAN’S MODEL Person (client system) : A composite of physiological, psychological, socio- cultural, developmental, and spiritual variables in interaction with the external and internal. Represented by a central structure, lines of defense, & lines of resistance.

13. CLIENTS VARIABLE

14. METAPARADIGM CONCEPTS (cont’d…) Environment : All external and internal factors influences the surrounding, the client system. Three relevant environments identified are the internal environment, the external environment, and the created environment.

15. METAPARADIGM CONCEPTS (cont’d…) Health :health is equated with the optimal system stability, it is viewed on a continuum of wellness to illness. Nursing : prevention as intervention, concerned with the all potential stressors.

16. PREVENTION

17. ANALYSIS OF NEUMAN’S SYSTEM MODEL

18. ASSUMPTIONS OF THE NEUMAN’S SYSTEM MODEL Provided support factors are in place, the client system constantly monitors self by making adjustments as needed to retain, attain, and maintain stability for an optimal health state. The client is an open system that interacts with the environment, so as to promote harmony and balance between the internal and external environments.

19. ASSUMPTIONS (Cont’d...) The client is a composite of physiological, psychological, socio- cultural, developmental,and spiritual variables that are viewed as parts of the whole. Each client system is unique. Each system is a composite of common known factors or innate characteristics within a normal, given range of response, contained within a basic structure.

20. ASSUMPTIONS (Cont’d...) Each person is born with a spiritual energy force or seed within the spiritual variable, as identified in the basic structure of the client system. The spiritual development in varying degree empowers the client system toward the well- being by positively directing spiritual energy for use first by the mind and then by the body.

21. ASSUMPTIONS (Cont’d...) The environment contains both the external and internal stressors and resistace factors. Stressors are considered neutral, the client encounter determines whether the outcome is beneficial or noxious. The client engages in a constant, dynamic energy exchange with the environment.

22. PROPOSITIONS OF THE NEUMAN’S SYSTEM MODEL Propositions of the N euman’s system model as presented by Fawcett. The client is system capable of input and output related to interpersonal, intrapersonal, and extrapersonal environmental influences , interacting with the environment by adjusting to it or adjusting the environment to itself. Input, output and feedback between the client and the environment are circular in nature.

23. PROPOSITIONS ( Co nt’d…) Many known, unknown, and universal environmental stressors exist. Each stressors differs in its potential for disturbing a client’s usual level of stability or normal line of defense. When cushioning effect of the flexible line of defense is no longer capable of protecting the client system against an environmental stresssors , the stressor breaks through the normal line of defense .

24. PROPOSITIONS ( Cont’d…) The line of resistance in the client system are activated to combat potential or actual stressor reactions. The client is an interacting open system in total interface with the e xternal and internal environmental factors or stressors. The process of interaction and adjustments results in varying degrees of harmony, stability, or balance between the client and the environment.

25. PROPOSITIONS ( Cont’d…) The major concern for nursing is keeping the client system stable by accurately assessing the current effects and possible effects of environmental stressors and assisting the client in making the adjustments required for an optimal level of wellness. In keeping the system stable, the nurse creates linkage among the client, environment, health and nursing.

26. BRIEF CRITIQUE OF THE NEUMAN SYSTEMS MODEL The Neuman systems model is a comprehensive conceptual model that clearly operationalizes the concepts that are relevant to nursing. The model is complex, yet organized in a logical manner. It is easy for nurses to understand for use in practice and research. The scope of model is broad, allowing for its use for individuals, families, groups or communities. Neuman’s model also incorporates the concepts of levels of prevention.

27. THE NEUMAN SYSTEMS MODEL AS A FRAMEWORK FOR NURSING PRACTICE

28. Using the N euman systems model as a framework for providing nursing care involves intervention at 3 levels of prevention : primary prevention intervention ,secondary prevention intervention and tertiary prevention intervention. The prevention as intervention format or mode identifies the entry point condition of the client system. It also indicates the general type of intervention o r action required. FRAMEWORK FOR NURSING PRACTICE

29. FRAMEWORK FOR NURSING PRACTICE (Cont’d..) Primary prevention as intervention is used for primary prevention as wellness retention –that is to protect the client system’s normal line of defense or usual wellness state by strengthening the flexible line of defense. The goal is to promote wellness by stress prevention and reduction of risk factors.

30. FRAMEWORK FOR NURSING PRACTICE (Cont’d..) The secondary prevention as intervention is used to protect the basic structure by strengthening the internal lines of resistance. The goal is to provide appropriate treatment of symptoms, to achieve optimal client system stability or wellness and energy conservation. The reconstitution is the determined energy increase related to the degree of reaction and is identified as beginning at any point following treatment.

31. FRAMEWORK FOR NURSING PRACTICE (Cont’d..) The tertiary prevention as intervention modality is used for tertiary prevention as wellness maintenance, to protect the client system’s reconstitution or return to wellness following treatment.

32. THE NURSING PROCESS AND THE NEUMAN SYSTEMS MODEL The Neuman systems model nursing process format has been designed for use with the Neuman systems model. This nursing process has been developed, so that it applies to 3 categories : nursing diagnosis, nursing goals, and nursing outcomes.

33. NURSING DIAGNOSIS CATEGORY(ASSESSMENT) The Nurse – patient relationships begins with the initial contact and is perceived as a partnership. Systemic data collection through physical assessment and interview process. Assessment includes physiological, psychological, developmental, socio-cultural , and spiritual variables

34. NURSING DIAGNOSIS (Cont’d..) Based on the assessment variances from wellness are identified and diagnoses are identified and prioritized. The guidelines for the use of the Neuman system model in practice stipulate that the diagnostic taxonomy employed reflects the following categories.

35. NURSING DIAGNOSIS (Cont’d..) T axonomy employed reflects the following categories : Client system ( individual, family, group, or community)  R esponse level ( primary, secondary or tertiary) Subsystem response (five variables) Stressor source ( intra system,inter system or extra system) Stressor type (five variables)

36. NURSING GOALS (PLANNING AND IMPLEMENTATION Goals and interventions are developed in partnership with the client specific outcome goals, along with primary prevention as intervention ,secondary prevention as intervention and tertiary prevention as intervention, modalities are developed to promote optimal client system stability.

37. NURSING OUTCOMES (IMPLEMENTATION AND EVALUATION) The Nurse implements the planned interventions (primary, secondary, or tertiary) in this phase. The Nurse evaluates and modifies these interventions as necessary, working in partnership with the client, based on the client system stability.

38. THE NURSING PROCESS AND THE NEUMAN SYSTEMS MODEL Variances from wellness are identified and diagnoses are identified and prioritized Goals and interventions are developed in partnership with the client to promote optimal client system stability Nursing outcomes ( implementation and Evaluation ) Implements prevention as intervention modalities and working in partnership with the client modifies interventions as necessary based upon client system stability Nursing Goals (Planning and Implementation) Nursing diagnosis category (Assessment)

39. SCENARIO : Illustrating Nursing Care Framed by the NEUMAN Systems Model Utilizing the NEUMAN Systems Model Nursing Process Format The following scenario illustrates nursing care of the patient relative to one identified nursing problem framed by the Neuman systems model. This scenario is not intended to cover all aspects care, but rather is intended to stimulate thinking about how specific care might be approached using this theory as a framework for practice .

40. SCENARIO : Illustrating Nursing Care Framed by the NEUMAN Systems Model Utilizing the NEUMAN Systems Model Nursing Process Format Ms.B , is a 32-year-old, obese single mother of three who presents to the clinic. Systemic data collection occurs through physical assessment and interview with Ms. B. The assessment includes physiological , psychological, developmental, sociocultural, and spiritual variables; basic structure, function, strengths, and resources available to Ms. B.; potential and actual environmental stressors; and characteristics of Ms. B's flexible and normal lines of defense, lines of resistance, degree of reaction, and reconstitution. Based on the assessment, it is determined that Ms. B. is experiencing an actual nutritional imbalance-more than body requirements--related to family and environmental stressors.

41. SCENARIO : Illustrating Nursing Care Framed by the NEUMAN Systems Model Utilizing the NEUMAN Systems Model Nursing Process Format The nurse, in partnership with Ms. B., develops goals and interventions. Specific outcome for Ms. B. include secondary prevention-as-intervention modalities to assist Ms. B. in addressing current family and environmental stressors as well as interventions aimed at expanding her flexible line of defense so as to promote system stability. In addition, if any other nursing problems are uncovered in more variables; basic structure, function, strengths, and resources; stressors; or lines of defense during the assessment, the  nurse addresses those problems simultaneously using the process described and incorporating best practices to provide appropriate nursing care.