BETTY NEUMAN’S SYSTEM MODEL
INTRODUCTIONBetty Neuman’s system model provides a
comprehensive flexible holistic and systembased perspective for nursing.
It focuses attention on the response of theclient system to actual or potentialenvironment stressors.
And the use of primary, secondary andtertiary nursing prevention intervention.
HISTORY AND BACKGROUND OF
THE THEORISTBorn in 1924
HISTORY AND BACKGROUND OF
THE THEORIST CONTD….• Initial nursing education with
double honors at PeoplesHospital School of Nursing,Akron Ohio, in 1947.
• B. Sc. in Nursing in 1957
• M. Sc. in mental health,public health consultation,from UCLA in 1966.
• PhD in clinical Psychology.
HISTORY AND BACKGROUND OF
THE THEORIST CONTD….• She was a pioneer in the community mental
health movement in the late 1960.
• She began developing her health systemmodel while a Lecturer in Community HealthNursing at University of California, LosAngeles.
• Published in the first edition of ConceptualModels for Nursing Practice, 1974, and in thesecond edition in 1980.
THE NEUMAN SYSTEM MODEL
(NSM) • TWO MAJOR COMPONENTS:
Stress
Reaction to stress
ASSUMPTIONS:
1. Each client system is unique.
2.Many known, unknown anduniversal stressors exist, withdifferent potential for disturbing aclient’s usual stability level ornormal line of defence.
ASSUMPTIONS CONTD….
3.The particular inter-relationships of client variables at
any point in time can affect the degree to which client is
protected by the flexible line of defence against
possible reaction to stressors.
4. Each client/client system has evolved a normal range of
responses to the environment that is referred to as a
normal line of defence. The normal line of defence can
be used as a standard from which to measure health
deviation.
ASSUMPTIONS CONTD….
5.When the flexible line of defence is no longer
capable of protecting the client/ client system
against an environmental stressor, the stressor
breaks through the normal line of defence.
6.The client whether in a state of wellness or
illness, is a dynamic composite of the inter-
relationships of the variables.
ASSUMPTIONS CONTD….
7.Implicit within each client system are internal
resistance factors known as line of resistance,
which function to stabilise and realign the client
to the usual wellness state.
8.Primary prevention relates to G.K. that is applied
in client assessment and intervention, in
identification and reduction of possible or actual
risk factors.
ASSUMPTIONS CONTD….
9.Secondary prevention relates to symptomatology
following a reaction to stressor, appropriate ranking
of intervention priorities and treatment to reduce
their noxious effects.
10.Tertiary prevention relates to adjustive processes
taking place as reconstitution begins and
maintenance factors move the back in circular
manner toward primary prevention.
ASSUMPTIONS CONTD….
11. The client as a system
is in dynamic, constant
energy exchange with
the environment
CONCEPTS IN NEUMAN’S
SYSTEM MODEL• The major concepts
are:
1.HOLISTIC
CLIENT
APPROACH: Here
the clients are
viewed as whole
whose parts are in
dynamic interaction.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….2.BASIC STRUCTURE/ CENTRAL CORE:
Common client survival factors in unique
individual characteristics representing basic
system energy resources.
• The basic structure or central core is made up of
basic survival factors that are common to the
species.
2.BASIC STRUCTURE/ CENTRAL
CORE contd....• These factors include: normal temperature
range, genetic structure-response pattern,
organ strength or weakness, ego structure.
• 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.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….3.CONTENT: The variables of the person in
interaction with the internal and external
environment comprise the whole client system.
4.OPEN SYSTEM: A system in which there is
continuous flow of input, output and feedback. It is
a system of organised complexity where all
elements are in interaction. E.g. stress and
reaction to stress.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….5. PROCESS OR FUNCTION: The exchange of
matter, energy and information with the
environment and the interaction of the parts and
supports of the system of man. A living system
tends to move toward wholeness.
6. INPUT AND OUTPUT: The matter, energy and
information exchanged between man and
environment, which is entering or leaving the
system at any point in time.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….7.FEEDBACK: The process within
which the matter, energy and
information as a system output
provides feedback for corrective
action to change, enhance or stabilise
the system.
8. ENTROPY: A process of energy
depletion and disorganisation moving
the system toward illness or possible
death.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….9.NEGENTROPY: A process of
energy conservation that increase
organisation and complexity,
moving the system toward stability
or a higher degree of wellness.
10.STABILITY: A state of balance or
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.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….11.FLEXIBLE LINE OF
DEFENCE: A protective,
accordion like mechanism that
surrounds and protects the normal
line of defence from invasion by
stressors.
12. NORMAL LINE OF DEFENCE:
It represents what the client has
become over time, or the usual
state of wellness. It is considered
dynamic because it can expand or
contract over time.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….
13.Line of resistance: The series of
concentric circles that surrounds the
basic structure.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….14. DEGREE OF REACTION: The
degree of reaction is the amount of
system instability resulting from
stressor invasion of the normal line
of defence.
15. RECONSTITUTION: The return
and maintenance of system
stability, following treatment for
stressor reaction, which may result
in a higher or lower level of
wellness.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….16.STRESSORS: These are the
environmental factors, intra
(emotion, feeling), inter (role
expectation), and extra personal
(job or finance pressure) in
nature, that have potential for
disrupting system stability.
• A stressor is any phenomenon
that might penetrate both the
flexible and normal line of
defence resulting either a
positive or negative outcome.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….17. WELLNESS/ILLNESS:-
Wellness 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.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….18. PREVENTION:
• According to Neumann’s
model, prevention is the
primary nursing
intervention. Prevention
focuses on keeping
stressors and the stress
response from having a
detrimental effect on the
body.
CONCEPTS IN NEUMAN’S
SYSTEM MODEL CONTD….
LEVELS OF
PREVENTION
Primary prevention
Secondary
prevention
Tertiary prevention
PARADIGM OF NEUMAN’S MODEL
FOUR MAJOR CONCEPTS ARE:
MAJOR CONCEPTS
PERSON
ENVIRONMENT
HEALTH
NURSING
FOUR MAJOR CONCEPTS
CONTD….1.PERSON:
The focus of the
Neumann model is
based on the philosophy
that each human being
is a total person as a
client system and the
person is a layered
multidimensional being.
FOUR MAJOR CONCEPTS
CONTD….• Each layer consists of five person variable or
subsystems: DEVELOPMENTAL
SPIRITUAL
SOCIO-CULTURAL
PSYCHOLOGICAL
PHYSIOLOGICAL
FOUR MAJOR CONCEPTS
CONTD….2. ENVIRONMENT:
The 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.
FOUR MAJOR CONCEPTS
CONTD….
INTERNAL
EXTERNAL
CREATED
ENVIRONMENT
FOUR MAJOR CONCEPTS
CONTD….
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)”.
FOUR MAJOR CONCEPTS
CONTD….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.
FOUR MAJOR CONCEPTS
CONTD….• 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.’’
• The role of the nurse is seen in terms of degree
of reaction to stressors, and the use of primary,
secondary and tertiary interventions.
THE NEUMAN SYSTEM MODEL AND THE
NURSING PROCESS:
• Neuman (1982-1995) presents a three step nursing
process format.
NURSING DIAGNOSIS
NURSING GOALS
NURSING OUTCOMES
NEUMANN’S SYSTEM MODEL
FORMAT
1. ASSESSMENT:
• Potential and actual stressors.
• Condition and strength of basic structure factors and
energy sources.
• Characteristics of flexible and normal line of defences,
lines of resistance, degree of reaction and potential for
reconstitution.
1. ASSESSMENT contd...
• Interaction between client and
environment.
• Life process and coping factors (past,
present and future) actual and potential
stressors (internal and external) for
optimal wellness.
• Perceptual difference between care giver
and the client.
NEUMANN’S SYSTEM MODEL FORMAT
CONTD….
2. NURSING DIAGNOSIS:
• The data collected are then interpreted to
condition and formulate the Nursing
diagnosis.
• Health seeking behaviours.
• Activity intolerance.
• Ineffective coping.
• Ineffective thermoregulation.
NEUMANN’S SYSTEM MODEL FORMAT
CONTD….
3. GOAL:
In Neumann’s systems
model the goal is to
keep the client system
stable.
NEUMANN’S SYSTEM MODEL FORMAT
CONTD….
4. PLANNING:
Planning is focused on
strengthening the lines
of defence and
resistance.
NEUMANN’S SYSTEM MODEL
FORMAT CONTD….
5. IMPLEMENTATION:
• The goal of stabilizing the client system is achieved
through three modes of prevention
Primary prevention : actions taken to retainstability
Secondary prevention : actions taken to attain
stability
Tertiary prevention : actions taken to maintainstability
NEUMANN’S SYSTEM MODEL FORMAT
CONTD….
6. EVALUATION:
The nursing process is
evaluated to determine
whether equilibrium is
restored and a steady
state maintained.
GLOBAL APPLICATIONS OF THE MODEL
1. CLINICAL PRACTICE:
The Neumann systems
model has been applied and
adapted to various
specialties include family
therapy, public health,
rehabilitation, and hospital
nursing.
One of the model’s
strengths is that it can be
used in a variety of settings.
GLOBAL APPLICATIONS OF THE MODEL
CONTD….
Using this conceptual model permits comparison
of a nurse’s interpretation of a problem with that
of the patient, so the patient and nurse do not
work on two separate problems.
The role of the nurse in the model is to work with
the patient to move him as far as possible along
a continuum toward wellness.
GLOBAL APPLICATIONS OF THE
MODEL CONTD….
Because this model requires individual
interaction with the total health care
system, it is indicative of the futuristic
direction the nursing profession is taking.
The patient is being relabelled as a
consumer with individual needs and wants.
GLOBAL APPLICATIONS OF THE
MODEL CONTD….2. EDUCATION:
It has often been
selected 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.
GLOBAL APPLICATIONS OF THE
MODEL CONTD….
One of the objectives for nursing graduate is to
demonstrate ability to use the Neumann health care
system in nursing practice. This helps prepare the
students for developing a frame of reference centred on
holistic care.
At north-western State University in Shreveport,
Louisiana, the faculty determined that a systems model
approach was preferred for their master’s program
because of the universality framework.
GLOBAL APPLICATIONS OF THE
MODEL CONTD….RESEARCH
• A study done by
Riehl and Roy to test
the usefulness of the
Neumann model in
nursing practice was
published in
conceptual models
for nursing practice
3rd edn in 1989.
GLOBAL APPLICATIONS OF THE
MODEL CONTD….
Results indicated that the model can help categorize
data for assessing and planning care and for guiding
decision making.
Neumann’s model can easily generate nursing research.
It does this by providing a framework to develop goals
for desired outcomes. Acceptance by the nursing
community for research applying this model is in the
beginning stages and positive.
REFERENCES1.Reed S Karen, “Betty Neuman (The neuman
system model), Notes on nursing Theories”,
SAGE publishers, Pp: 1-29.
2.Parker Marilyn, “Nursing theories and nursing
practice”, FA Davis publishers, Pp: 330-340.
3.Basvanthappa BT, “Nursing Theories”2nd edn,
Jaypee publishers, Pp: 225-241.
•
REFERENCES CONTD….4. Mary Walton, “The nursing journal of India”, October
2009, vol C No. 10, Pp: 230-232.
5. Gunusen Partlak Neslihan, Ustun Besti, Gigliotti Eileen,
“Nursing Science Quarterly theory, research and practice”,
vol 22, number 3 July 2009, Pp: 200-204.
6. Flanagan Jane, “Nursing Science Quarterly theory,
research and practice”, vol 22, No. 2, April 2009, Pp: 160-
161.
•
REFERENCES CONTD….
7.http://currentnursing.com/nursing_theory/N
euman.htm.
8.http://currentnursing.com/nursing_theory/app
lication_Betty_Neuman’s_Model.htm.
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