Title

GINERASUBJECT: ADVANCED NURSING PRACTICE

TOPIC : BETTY NEUMAN’S THEORY

PREPARED BY-PANDIT KHYATI R.F.Y.M.SC.NURSING

TERMINOLOGIES

THEORYA series of ideas

and general principles which seek to explain

some aspects of the world.

MODELA small scale

representation of something that

serves as a guide in constructing the full scale version.

SYSTEMA set of

interconnected or interrelated parts forming a complex

whole.

MS.BETTY NEUMAN(1924)

HISTORY AND BACKGROUND

• Betty Neumann was born in 1924, in Lowel, Ohio.

• Completed B.Sc. nursing in 1957, and M.S. in Mental Health Public health consultation, from UCLA in 1966.

• She holds a Ph.D. in clinical psychology.

HISTORY AND BACKGROUND

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, in 1974, and in the second edition in 1980.

INTRODUCTIONProvides 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.Use of primary, secondary and tertiary nursing prevention intervention for retention, attainment, and maintenance of optimal client system wellness.

BASIC ASSUMPTIONS

1.Each client system is unique, a composite of factors and characteristics within a given range of responses contained within a basic structure. I am

unique

BASIC ASSUMPTIONS

2. Many known, unknown and universal stressors exist. Each differ in it’s potential for disturbing a client’s usual stability level or normal Line of Defense.

BASIC ASSUMPTIONS

3. Stressors both universal and known; some are unique to the client. They have potential to disturb equilibrium, thus causing a change in priority of needs at any given moment.

Stressors disturbs the normal equilibrium

BASIC ASSUMPTIONS

4. Man is a composite of the interrelationship of the four variables ( biological, psychological, socio-cultural and developmental) which are at all times present.

BASIC ASSUMPTIONS

5. Each client/ client system has evolved a normal range of responses to the environment that is referred to as a normal Line of Defense. The normal Line of Defense can be used as a standard from which to measure health deviation.

BASIC ASSUMPTIONS

When the flexible Line of Defense is no longer capable of protecting the client/ client system, against an environmental stressor, the stressor breaks through the normal Line of Defense.

BASIC ASSUMPTIONS

8.Primary prevention relates to general knowledge applied to clients assessment to identify stressors before they occur.

BASIC ASSUMPTIONS

9.Secondary prevention relates to symptomatology. These are interventions generally initiated after an encounter with a stressor.

BASIC ASSUMPTIONS

10.Tertiary prevention relates to the adaptive process, as reconstitution begins and moves back towards primary prevention. These are the interventions initiated after treatment.

MAJOR CONCEPTS OF NEUMANN'S THEORY

FOUR MAJOR CONCEPTSPerson

Environment

Health

Nursing

1.PERSON Each layer consists of five person variable Physiological- Refer to the physiochemical 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.

CORE Lines of Resistance

Normal Line of Defense

Flexible Line of Defense

CORE Normal Line of Defense Normal Line of Defense Normal Line of Defense

2.ENVIRONMENT internal environment - within the client system. external environment - outside the client system. created environment-created and developed unconsciously by the client and is symbolic of system wholeness.

CORE

Flexible Line of Defense

Normal Line of Defense

Lines of Resistance

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

3.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 (Neumann, 1995)”.

3.Health

The client system moved toward wellness when more energy is available than is needed.

The client system moves toward illness and death when more energy is needed than is available.

.Monday, May 1, 2023 23

CORE

S

T

R

E

S

S

O

R

S

Extraperson

S

T

R

E

S

S

O

R

S

LINES OF RESISTANCE

NORMAL LINE OF DEFENSE

FLEXIBLE LINE OF DEFENSE

Intraperson

Extraperson

Intraperso

Interpersonal

Extrapersonal

Intrapersonal

Interpersonal

Extrapersonal

Intrapersonal

CORE

4. 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. Monday, May 1, 2023 25

4. Nursing

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.’’ Monday, May 1, 2023 26

4. NURSING The role of the nurse is seen in terms of degree of reaction to stressors, and the use of primary, secondary and tertiary interventions.

Primary Prevention

Secondary Prevention

Tertiary Prevention

Monday, May 1, 2023 27

CORE

Normal Line of Defense(Secondary Prevention)

Lines of Resistance (Tertiary Prevention)

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

Health

CORE

Harmony StabilityBa

lanc

e

Health

Wellness

HealthHealth

Flexible line of defense(Primary prevention)

Once an individual is exposed to stress, the flexible line of defense will be “alarmed” to protect the normal (solid) line of defense to keep the system free from stressor reactions.

However, if this individual is continuously exposed to stress and if the flexible line of defense is unable anymore to cope up with the stressors, the normal line of defense will be altered. If this happens, there will be a threat to the wall that protects the basic structure of the individual and therefore causing instability of the systems and illness develops.

ILLNESS

Normal Line of Defense CORE

S T R E S S O R S(Intrapersonal, Interpersonal,

Extrapersonal)

I L L N E S S

Flexible Line of Defense

Lines of ResistanceCORE

Monday, May 1, 2023 31

Primary prevention

Secondary prevention

Tertiary prevention

Stressors

Reaction

Interventions Reconstitution

Stressors

Stressors

Basic structure and Line of

Defense

The Neuman System Model (3 rd edition, 1995)

Copyright 2005 by Dr. Betty Neuman 32

STAGES OF NURSING PROCESS (BY NEUMAN)

NURSING DIAGNOSIS NURSING GOAL NURSING OUTCOME

STAGES OF NURSING PROCESS (BY NEUMAN)

1. 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.

STAGES OF NURSING PROCESS (BY NEUMAN)

2. NURSING GOALS• These must be negotiated with the patient, and take

account of patient’s and nurse’s perceptions of variance from wellness.

3. 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.

NEUMANN’S SYSTEM MODEL FORMAT

ASSESSMENT

NURSING DIAGNOSIS

GOAL

PLANNING

IMPLEMENTATION

EVALUATION

Monday, May 1, 2023 36

ASSESSMENT• Assess for - 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

PRACTICE

EDUCATION

RESEARCH ADMINISTRARION

PRACTICE

FAMILY THERAPY, PUBLIC HEALTH,

REHABILITATION, AND HOSPITAL

NURSING.

THE SUB SPECIALTIES

INCLUDE PULMONARY,

RENAL, CRITICAL CARE, AND

HOSPITAL MEDICAL UNITS.

•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.

•Developing a frame of reference centered on holistic care.

EDUCATION

• Method of collecting and analyzing data for identifying client problems.

• The identification of congruence between the client’s perception of stressors and the care giver’s perception of client stressors.

RESEARCH

• Case management of patients.

• Total quality management is used to prepare health care administrators for future.

ADMINISTRATION

SAMPLE SITUATION: Mr. Yoso is a 38 year-old business executive.

His colleagues describe him as hard working, perfectionist, and very dedicated to work. His day starts by leaving the house very early from Laguna to Makati and begins work by delegating various tasks with firm expectations and deadlines that somewhat impossible to meet. He usually responds with pressure and intimidating remarks for works not perfectly done. He smokes and drinks alcohol whenever he is stressed. Recently, the company experienced continuous dropped in their sells and his bosses started to put blame to him.

continuation…

Mr. Yoso began exhibiting weird mannerisms and behaviors that appear strange to his family and people around him. He misses breakfast and lunch very often and sleeps very late at night while doing work. He has no time anymore for his family and focuses to hard on meeting deadlines and his preconceived objectives. Because of these weird changes in him, the company decided to temporarily relieve him from his position as executive manager. A week later, he started to have periods of mania and depression. His family becomes worried and called up the hospital to seek assistance after he locked himself in the room, refusing to eat, and most of the time quiet and staring blankly on the wall. Later, he developed pneumonia.

Using Neuman’s System Model in the above situation, the identified possible stressors that contributed to Mr. Yoso’s condition were as follows: work, personality, and attitude. Mr. Yoso is not anymore able to handle the stressors and that had caused the “breakdown” of his lines of defense. Without seeking help from his family and friends, he was not able to maintain his flexible line of defense and brought instability to his system. (The diagram on the next page shows the effect of the stress in his lines of defense and the corresponding prevention that might have or may be done to prevent illness/or complications from occurring.)

CORE

Effects on Normal Line of Defense: • exhibiting weird

mannerisms and behaviors

• periods of mania and depression

Tertiary Prevention• Re-assessing patient’s ability

to independently perform and maintain variables of health.

• Regular consult to psychologist.

• Maintaining client’s support system

Secondary Prevention• Medication (to treat

symptoms)• Opportunities to

verbalize feelings and concerns

Effects on Lines of Resistance: • weakened immune

response• developed

pneumonia

Primary Prevention:• Stress management

activities• Relaxation techniques• Anger-management

techniques• Smoking cessation

Effects on Flexible Line of Defense: • sleeps very late at night• misses breakfast and lunch• responds with pressure and

intimidating remarks for works not perfectly done

• smokes and drinks alcohol whenever he is stressed

Work-related stressors

CORE

LIMITATION• Neuman has explained nicely

about the prevention but the other factors that will help in reconstitution as well as maintenance of the stability of client like, peer group, family, and many others are not explained.

NEUMAN’S SYSTEM MODEL CONCEPT MAP:

NEUMAN’S SYSTEMS MODEL CONCEPT MAP

CLIENTSPIRITUAL

PHYSIOLOGICAL

DEVELOPMENTAL

PSYCHOLOGICAL

SOCIOCULTURAL

ENVIRONMENT

INTERNAL EXTERNAL

CREATED

HEALTH

WELLNESS ILLNESS

NURSING

PREVENTION

PRIMARY

SECONDAR

Y

TERTIARY

NURSING

PROCESS

DIAGNOSIS

GOALS

OUTCOMES

“Health is a condition in which

all parts and subparts are in

harmony with the whole of the

client.”