BETTY NEUMAN

SYSTEM MODEL

Born on a farm on Lowell, Ohio in 1924.

She received her BS in Nursing in 1957 at People's Hospital, Ohio. Her MS in Mental Health, Public Health Consultation from UCLA in 1966 and she holds a PhD in clinical psychology.

Her teaching experience includes mental health, consultation and organization, leadership, and counseling.

As a mental health counselor, she developed her nursing model of the “whole person approach” based on a system adaptation framework.

NEUMAN’S SYSTEM MODELThe model was initially developed in response to graduate nursing students’ expression of a need for course content that would expose them to a breadth of nursing problem prior to focusing on specific nursing problem areas.The model was published in 1972 as a “Model for Teaching Total Person Approach to Patient Problem,” in Nursing Research. It was later refined and was published in the first edition of Conceptual Models for Nursing Practice in 1974.

Neuman described her model as comprehensive and dynamic. The model is multidimensional view of individual, groups (families), and communities, who are in constant interaction with environmental stressors. Essentially, the model focuses on the client’s reaction to stress and the factors of reconstitution or adaptation. It is considered an appropriate model not only for nursing but also for all health professions.

Neuman’s conceptual approach is the result of synthesis of knowledge from several theoretical sources, including: de Chardin, Marx, Gestalt, Selye, von Bertalanffy, and Caplan.

NEUMAN'S THEORY AND THE FOUR MAIN CONCEPT

1. INDIVIDUAL/ HUMAN - focused on the philosophy that each human is a “total person” as a client and that this is multidimensional, a composite of physiological, psychological, sociocultural, developmental and spiritual variables. The interaction of theses variable with the lines of normal defense and flexible resistance, combined with multiple stressors, provide the essence of “total person approach.”

2. SOCIETY/ENVIRONMENT – the concept on which humans are in constant interaction with their environment. It is defined as those internal and external forces surrounding the human at any given point in time. The created environment is intra-, inter- and extrapersonal.

Stressors: More than one stressors can occur at a time

• Extrapersonal – forces that occur outside the system

• Interpersonal – forces occurring between one or more individuals

• Intrapersonal – forces that occur within the individual

3. HEALTH/WELLNESS – Neuman does not define health but stated that through an interaction/adjustment process, a person retains varying degree of balance and harmony between internal and external environments.

WELLNESS – is equated with optimal stability of the normal line of defense; state of saturation; of inertness free; and of disruptive needsILLNESS – state of insufficiency; disruptive needs are yet to be satisfied.RECONSTITUTION – can be equated with moving from “variances from wellness” to desired wellness levels and client stability which is viewed holistically.

4. NURSING – is a “unique profession” that concerns itself with all the variables affecting human response to stressors, with a primary concern for the total person. Its goal is the retention and attainment of client system stability.

Neuman has systematized the nursing process into three categories of nursing diagnosis, nursing goals, and nursing outcomes.

• Reaction: can begin at any point at which a stressor is either expected or identified.

• Primary Prevention –If a reaction had not occurred, the intervention would enter at the primary level. Its goal is to prevent the stressor from penetrating the normal line of defense or lessen the degree of reaction by reducing the possibility of encounter with stressors and by strengthening the line of defense.

• Secondary Prevention – If primary prevention is not possible and a reaction has occurred, intervention would begin at the secondary prevention. Deals mainly with early case finding, early treatment of symptoms and attempts to strengthen the internal lines of resistance to reduce reaction. Nursing interventions at this level can begin at any point where stress reaction is recognized. It may progress beyond or below the usual level of wellness or line of defense.

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• Tertiary prevention – is the intervention that follows that active treatment plan when reconstitution or some reasonable degree of stabilization has occurred. The goal is to maintain this adaptation in strengthening the lines of resistance, thus preventing future occurrences and by optimum use of the system's total resources, including the internal and external environment.