- Theorist - Betty Neuman - 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
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Theory was publlished in:
- “A Model for Teaching Total Person Approach to Patient Problems” in Nursing Research - 1972.
- "Conceptual Models for Nursing Practice", first edition in 1974, and second edition in 1980.
- Betty Neuman’s system model provides a comprehensive flexible holistic and system based perspective for nursing.
DEVELOPMENT OF THE MODEL
Neuman’s model was influenced by:
- The philosophy writers deChardin and Cornu (on wholeness in system).
- Von Bertalanfy, and Lazlo on general system theory.
- Selye on stress theory.
- Lararus on stress and coping.
BASIC ASSUMPTIONS
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Each client system is unique, a composite of factors and
characteristics within a given range of responses contained within a
basic structure.
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Many known, unknown, and universal stressors exist. Each
differ in it’s potential for disturbing a client’s usual stability
level or normal LOD (Line of Defence).
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The particular inter-relationships of client variables at
any point in time can affect the degree to which a client is protected
by the flexible LOD against possible reaction to stressors.
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Each client/ client system has evolved a normal range of
responses to the environment that is referred to as a normal LOD. The
normal LOD can be used as a standard from which to measure health
deviation.
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When the flexible LOD is no longer capable of protecting
the client/ client system against an environmental stressor, the
stressor breaks through the normal LOD
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The client whether in a state of wellness or illness, is a
dynamic composite of the inter-relationships of the variables.
Wellness is on a continuum of available energy to support the system in
an optimal state of system stability.
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Implicit within each client system are internal
resistance factors known as LOR, which function to stabilize and
realign the client to the usual wellness state.
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Primary prevention relates to G.K. that is applied in
client assessment and intervention, in identification and reduction of
possible or actual risk factors.
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Secondary prevention relates to symptomatology
following a reaction to stressor, appropriate ranking of intervention
priorities and treatment to reduce their noxious effects.
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Tertiary prevention relates to adjustive processes
taking place as reconstitution begins and maintenance factors move the
back in circular manner toward primary prevention.
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The client as a system is in dynamic, constant energy exchange with the environment.
MAJOR CONCEPTS (Neuman, 2002)
Content
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the variables of the person in interaction with the internal and external environment comprise the whole client system
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The common client survival factors in unique individual characteristics representing basic system energy resources.
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The basis structure, or central core, is made up of the
basic survival factors which include: normal temp. range, genetic
structure.- response pattern. organ strength or weakness, ego
structure.
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Stability, or homeostasis, occurs when the amount of energy that is available exceeds that being used by the system.
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A homeostatic body system is constantly in a dynamic
process of input, output, feedback, and compensation, which leads to a
state of balance.
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the amount of system instability resulting from stressor invasion of the normal LOD.
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a process of energy depletion and disorganization moving the system toward illness or possible death.
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a protective, accordion like mechanism that surrounds and protects the normal LOD from invasion by stressors.
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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.
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The series of concentric circles that surrounds the basic structure.
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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
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The matter, energy, and information exchanged between
client and environment that is entering or leaving the system at any
point in time.
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A process of energy conservation that increase
organization and complexity, moving the system toward stability or a
higher degree of wellness.
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A 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.
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Interventions modes for nursing action and determinants for entry of both client and nurse in to health care system.
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The return and maintenance of system stability,
following treatment for stressor reaction, which may result in a higher
or lower level of wellness.
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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.
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environmental factors, intra (emotion, feeling), inter
(role expectation), and extra personal (job or finance pressure) in
nature, that have potential for disrupting system stability.
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A stressor is any phenomenon that might penetrate both the F and N LOD, resulting either a positive or negative outcome.
- 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 (Neuman, 2002).
Prevention
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the primary nursing intervention.
- focuses on keeping stressors and the stress response from having a detrimental effect on the body.
- Primary Prevention
- occurs before the system reacts to a stressor.
- strengthens the person (primary the flexible LOD) to enable him to better deal with stressors
- includes health promotion and maintenance of wellness.
- Secondary Prevention
- occurs after the system reacts to a stressor and is provided in terms of existing system.
- focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor.
- Tertiary Prevention
- occurs after the system has been treated through secondary prevention strategies.
- 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
PERSON
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Human being is a total person as a client system and the person is a layered multidimensional being.
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Each layer consists of five person variable or subsystems:
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Physiological - Refers of the physicochemical structure and function of the body.
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Psychological - Refers to mental processes and emotions.
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Socio-cultural - Refers to relationships and social/cultural expectations and activities.
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Spiritual - Refers to the influence of spiritual beliefs.
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Developmental - Refers to those processes related to development over the lifespan.
ENVIRONMENT
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"the totality of the internal and external forces
(intrapersonal, interpersonal and extra-personal stressors) which
surround a person and with which they interact at any given time."
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The internal environment exists within the client system.
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The external environment exists outside the client system.
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The created environment is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness.
HEALTH
- Health is equated with wellness.
- “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
NURSING
- a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor.
- 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.’’
- 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 MODEL & CHRACTERISTICS
- interrelated concepts
- logically consistent.
- logical sequence
- fairly simple and straightforward in approach.
- easily identifiable definitions
- provided guidelines for nursing education and practice
- applicable in the practice
Research Articles
- “Using the Neuman Systems Model for Best Practices’’--Sharon A. DeWan, Pearl N. Ume-Nwagbo, Nursing Science Quarterly, Vol. 19, No. 1, 31-35 (2006).
- Melton L, Secrest J, Chien A, Andersen B. “A community needs assessment for a SANE program using Neuman's model” J Am Acad Nurse Pract. 2001 Apr;13(4):178-86.
CONCLUSION
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Betty Neuman’s system model provides a comprehensive flexible holistic and system based perspective for nursing.
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Neuman's model focuses on the response of the
client system to actual or potential environmental stressors and the
use of primary, secondary and tertiary nursing prevention intervention
for retention, attainment, and maintenance of optimal client system
wellness.
REFERENCES
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Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, NY.
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George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange.
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Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
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Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott.
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Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
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Potter A Patricia, Perry G Anne (1992) Fundamentals
Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year
Book.
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Vandemark L.M. Awareness of self & expanding
consciousness: using Nursing theories to prepare nurse –therapists Ment
Health Nurs. 2006 Jul; 27(6) : 605-15
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Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225
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Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd edition, Thomson, NY, 2002
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