Betty Neuman's System Betty Neuman's System ModelModel

•Betty Neuman was born in 1924, in Lowel, Ohio. •BS in nursing in 1957 •MS in Mental Health Public health consultation, from UCLA in 1966.•Ph.D. in clinical psychology •a pioneer in the community mental health movement in the late 1960s. •developed the model while working as a lecturer in community health nursing at University of California, Los Angeles. •The model was 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, 1974, and in the second edition in 1980.

Viewed the client as an open system consisting of a basic structure or central

core of energy resources

concentric circles1. Physiological - refers of bodily structure and function.2. Psychological - refers to mental processes, functioning

and emotions.3. Sociocultural - refers to relationships; and

social/cultural functions and activities. 4. Spiritual - refers to the influence of spiritual beliefs.5. Developmental - refers to life’s developmental

processes.

Central core/ Basic Structure Energy Resources

1. Normal temperature range – body temperature regulation ability

2. Genetic structure – Hair color and bodily features3. Response pattern – functioning of body systems

homeostatically4. Organ strength or weakness 5. Ego structure6. Knowns or commonalities – value system

The person's system is an open system - dynamic and constantly changing and evolving

Stability, or homeostasis, occurs when the amount of energy that is available exceeds that being used by the system.

A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance

Flexible LODIt is a protective, accordion like mechanism

that surrounds and protects the normal LOD from invasion by stressors.

Keeps the system free from stressors and is dependent on the amount of sleep, nutritional status, as well as the quality and quantity of stress an individual experiences.

If the flexible line of defense fails to provide adequate protection to the normal line of defense, the lines of resistance become activated.

Normal LODThe usual state of wellness. It is considered dynamic in response to

coping or responding to the environment, which includes intelligence, attitudes, problem solving and coping abilities. ◦Example is skin which is constantly smooth and

fair will eventually form callous over times.

Line of Resistance-LOR Protection factors activated when

stressors have penetrated the normal LOD, causing a reaction symptomatology.

E.g. mobilization of WBC and activation of immune system mechanism

Input- outputThe matter, energy, and information

exchanged between client and environment that is entering or leaving the system at any point in time.

Open systemA system in which there is continuous flow of input and process, output and feedback. It is a system of organized complexity where all elements are in interaction.

Prevention as intervention

Interventions modes for nursing action and determinants for entry of both client and nurse in to health care system.

ReconstitutionThe return and maintenance of system

stability, following treatment for stressor reaction, which may result in a higher or lower level of wellness.

Stability

A state of balance of harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health thus preserving system integrity.

StressorsIs any environmental force which can

potentially affect the stability of the system

Intrapersonal - occur within personInterpersonal - occur between individualsExtrapersonal - occur outside the

individual

Wellness/IllnessWellness is the condition in which all

system parts and subparts are in harmony with the whole system of the client.

Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002).

Illness is an excessive expenditure of energy… when more energy is used by the system in its state of disorganization than is built and stored; the outcome may be death (Neuman, 2002).

PREVENTIONthe primary nursing intervention.

Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body.

Primary Prevention Primary prevention occurs before the

system reacts to a stressor. On the one hand, it strengthens the person (primary the flexible LOD) to enable him to better deal with stressors

Primary prevention includes health promotion and maintenance of wellness.

Secondary PreventionSecondary prevention occurs after the

system reacts to a stressor and is provided in terms of existing system.

Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor.

Tertiary PreventionTertiary prevention occurs after the

system has been treated through secondary prevention strategies.

Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.

FOUR NURSING PARADIGMS FOUR NURSING PARADIGMS PERSON Human being is a total person as a client system

and the person is a layered multidimensional being.

Each layer consists of five person variable or subsystems: ◦ Physiological - Refers of the physicochemical 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.

ENVIRONMENTThe environment is seen to be the totality of the

internal and external forces which surround a person and with which they interact at any given time.

These forces include the intrapersonal, interpersonal and extra-personal stressors which can affect the person’s normal line of defense and so can affect the stability of the system. ◦ The internal environment exists within the client system. ◦ The external environment exists outside the client

system. ◦ The created environment is an environment that is

created and developed unconsciously by the client and is symbolic of system wholeness.

HEALTHHealth as being equated with wellness.

Health/wellness is defined as “the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman, 1995)”.

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

NURSINGNeuman 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.

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.’’

Neuman states that, because the nurse’s perception will influence the care given, then not only must the patient/client’s perception be assessed, but so must those of the caregiver (nurse).

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

Neuman’S SYSTEM MODEL Neuman’S SYSTEM MODEL FORMATFORMAT

ASSESSMENTPotential 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 preventionPrimary 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.