Nursing Theorist

Betty Neuman, PhD, RN,

FAAN

Vinitha Manuel
Rebekkah McConnell
Wendy Szymoniak
Ericca Whitlow
Why The Neuman Systems
Model?
The Neuman Systems Model is
well positioned as a directive for a
truly wholistic perspective for
nursing. Its concepts and
processes are relevant for the
twenty-first century and beyond.
Its universal and timeless nature
has long proven its value in being
utilized effectively by health care
professionals in any cultural
setting (Alligood & Tomey, 2010).
Focusing on the nursing model
of Betty Neuman, PhD, RN,
FAAN
Delivers different aspects that are
affecting to a clients health condition
Assists nurses in providing care using
a holistic approach
Focuses on the nursing process:
assessment, diagnosis, intervention,
evaluation
Focuses on client related stressors:
how to diagnose, treat, and manage
stress
The Neuman Systems Model
The Neuman Systems Model
requires the care of the
patient to be comprehensive.
Nurse's should consider more
than the surgical intervention
the patient has undergone in
addition to looking at the
patients overall concept of
their illness and their
environment.
I believe this models allows
me to best see the whole of
the person I am treating;
increasing my critical
thinking skills in relation to
the larger picture and not a
single diagnosis.
The Neuman Systems Model
Historical Background
This model was developed because
nursing graduates felt they needed to be
exposed to course content that would give
them a variety of general nursing
problems prior to focusing on specific
nursing problems. It was first published in
1972 as A Model for Teaching Total Person
Appropriate Patient Problems later
published in the first edition of Conceptual
Models for Nursing Practice in 1974 and
then refined to second edition in 1980
(Alligood & Tomey, 2010).
Philosophic values: Nursing and
knowledge development
The Neuman Systems
Model reflects wellness and
illness in people that are
approached wholistically
to provide a unifying
focus that will assist
nurses in understanding the
client through interaction
with the perceived or actual
environmental stressors in
order to prevent illness or
to intervene and implement
appropriate goals post
illness and/or injury
(Alligood & Tomey, 2010).
Influenced: Authors
Philosophy
Betty Neuman developed The Systems Model
by incorporating from several other theorist not
limited to Lararus, Selyl, Von Barlatanfy(1968),
and from the Gestalt Theory (Pearls 1973)
(Alligood & Tomey, 2010). Also, drawing from
her own beliefs and clinical nursing
experiences, she has obtained a bachelors
degree in public health and psychology in
1957, her MS in mental health, public health
consultation in 1966, and doctoral degree in
clinical psychology in 1985. Her mental health
nursing experience was the most influential to
her theory (Alligood & Tomey, 2010).
Four Global Concepts
Human Being
Environment
Health
Nursing
(Alligood&Tomey,
2010)
Nursing Metaparadigm: Human
Being
Believes client may
be an individual,
family, group,
community, social
issue
Composes
interrelationships:
physiological,
psychological,
sociocultural,
developmental, and
spiritual factors
Nursing Metaparadogm: Human
Being (cont.)
The layers, usually represented by concentric
circle, consist of the central core, lines of
resistance, lines of normal defense, and lines
of flexible defense. The basic core structure
is comprised of survival mechanisms
including: organ function, temperature
control, genetic structure, response patterns,
ego, and what Neuman terms known and
commonalities. Lines of resistance and two
lines of defense protect this core. Around the
basic core structures are lines of defense and
resistance (Hayman, 2000)
Environment: Internal & external
factors
Internal
Correlated with the
interpersonal factors
and is a stressor that is
contained completely
within the client or
client system
External
Consists of all the
stressors that exist
outside the client but
affect the well being
and health of the client
or client system
Environment (cont.)
3 environments
Internal: Interpersonal-all
interactions contained within the
client
External: Interpersonal & extra
personal-outside the client
Created: Intrapersonal-
unconsciously developed; supports
protective coping influenced by
changes in clients state of wellness
Health
Wellness Model
Dynamic in nature
and constantly
changing
Optimal wellness or
stability indicates
that total system
needs are being
met. A reduced
state of wellness is
a results of unmet
systemic needs
Health (cont.)
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 (Neuman, 1995). As the
person is in a constant interaction with the
environment, the state of wellness (and by implication
any other state) is in dynamic equilibrium, rather than
in any kind of steady state. Neuman proposes a
wellness-illness continuum, with the person's position
on that continuum being influenced by their
interaction with the variables and the stressors they
encounter. The client system moves toward illness
and death when more energy is needed than is
available. The client system moves toward wellness
when more energy is available than is needed.
Nursing
Nursing is a holistic
approach (caring for the
patient as a whole). They
respond to stressors and
are the advocate for the
patents, in which the
nurses need to addresses
the stressors.
Views nursing as a
unique profession that it
is concerned with all of
the variables affecting an
individuals response to
stress (Alligood &
Tomey, 2010).
Nursing (cont.)
Neuman defines nursing as
actions 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 (Hayman, 2000).
Clarification of Origins
The Neuman Health Care Systems model originated as a result
of the need to develop a broad-based conceptual framework of
curriculum design, providing unity, integration and co-ordination
of the nursing course content(Parr,1993).
The idea behind this model is that nursing is about the total
person and it is an inimitable profession that is apprehensive
about the variable affecting and person in response to stress.
This model is about a total persons attitude and it is focused on
bringing together an effort to different nursing problems and for
understanding man and his environment.
It takes an open system approach, a system that is never at rest
because it is always trying to maintain homeostasis among
stressors (Parr,1993).
The models was initially developed in response to graduate
nursing students expression of a need for course content that
would expose them to breadth of nursing problems prior to
focusing on specific nursing problem areas.
Is this philosophy unique to
nursing?
This philosophy provides
a broad adaptable holistic
and system based point
of view for nursing
The main focuses on
client system to actual or
potential environmental
stressors and the use of
preventive measures,
such as primary,
secondary and tertiary
prevention and their
intervention for
maintaining the clients
optimal system wellness
Neumans Model: Primary
Prevention
Primary Prevention
Used when stressors are suspected
or recognized
Purpose: decrease the stressor
and/or decrease the reaction
(Alligood & Tomey, 2010)
Nuemans Model: Secondary
Prevention
Includes interventions or treated
after symptoms from the
stressor(s) have arose
Clients internal and external
strengthen
Reduces the reaction
Increases resistance factors
(Alligood & Tomey, 2010)
Nemans Model: Tertiary
Prevention
Occurs after treatment or
secondary prevention stage
Focuses on modification for client
system stability
Maintains wellness; prevention of
reoccurrence
Avoiding stressors that the client
recognizes as being harmful
(Alligood & Tomey, 2010)
 Occurs
after
Neumans Model: treatment for
Reconstitution stressor
reactions
Maintains system
strength which in
turn advances or
worsens the
wellness before
the stressor is
involved
(Alligood &
Tomey, 2010)
What or who influenced this
model?
The
philosophy of writers such as
deChardin
Pierre Tielhard deChardin was a priest and
a scientist who came up with spiritual
evolution. He believed in the idea that the
humans are more spiritually growing into
an ultimate excellence called Omega Point.
He is most often associated with the idea of
a mind mesh, the interconnectedness of
human spirit and mind, similar to Carl
Jung's collective unconscious.
Gestalt theory Hans Selye's
Gestalt Theory is a theory of German origin
that is about the concept of whole. Its
underlines the primacy of phenomena (the
perceived), asserting that the human world
of experience is the only immediately given
reality. The collaboration of the individual
and the situation controls the experience
and behavior (meaning that no two
interactions will ever be the same and we
should not simplistically over generalize)
(Hayman, 2000).
What or who influenced this
model? (cont.)
General Adaptation Syndrome
The General Adaptation Syndrome is
universal and it is taught in health classes in
high school. It suggests that there is a
common response to stress. First is the
alarm stage, then the resistance stage and
the third is the exhaustion stage. In alarm
stage the body starts to prepare to deal with
the stressor. The resistance stage, the body
likes to be in homeostasis or resting state,
the body work hard to become normal. Then
last is the exhaustion stage where the body
gets tired and collapse.
General Systems Theory
This theory talks about the thermodynamics
which is part of physics, chemistry and
engineering. Thermodynamics is the study
of the flow of energy from one system to
another. It is about the world is like the
thermodynamics which is there is a flow of
energy from one thing to another and they
are interconnected and influenced by each
other to function in a high organized manner.
If there is something not functioning then
the whole system will fail.
Narrow View?
Accordingto
This model may be currentnursing.com, this
used anywhere in a model may be used:
clinical setting. To assess the patient condition by
the various methods explained by
Ways of using this the nursing theory
To identify the needs of the
model include patient
nursing processes To demonstrate an effective
communication and interaction
such as with the patient.

assessment, To select a theory for the

application according to the need
nursing diagnosis, of the patient
To apply the theory to solve the
outcome, identified problems of the patient
implementation, To evaluate the extent to which
the process was fruitful (Betty
and evaluation. neuman, 2011)
Neuman and Koertvelyessy
Generated two Use of the model
theories from develops middle
range theory
this model research based on
The theory: practice
Optimal client Further research is
system stability needed to validate
The theory: the relationship
Prevention as between models
intervention concepts and
(Alligood & research outcomes
Tomey, 2010) (Alligood & Tomey,
2010)
Critique
Neumans model provides nurses and
other healthcare professionals a wide
range of creativity in its use; past,
present, and future.
Clarity
Simplicity
Generality
Empirical Precision
Derivable Consequences
Application in Practice (Alligood & Tomey,
2010)
Clarity
The models
clarity was
criticized in that
its concepts
needed to be
defined more
completely
(Alligood &
Tomey, 2010)
Simplicity
Complex in nature-can not be
described as simple framework
Nurses using the model describe
it as easy to understand and use
across cultures and in a wide
variety of practice settings
(Alligood & Tomey, 2010).
Generality
Comprehensive and adaptable
Concepts are:
Broad and represent the
phenomenon of the client
Definitive
Identify modes of actions (four
preventions) (Alligood & Tomey,
2010)
Empirical Precision
The Research Institute and nurse
researchers plan to increase the
empirical precision as research
continues and findings from
multiple studies are created
(Alligood & Tomey, 2010)
Derivable Consequences
Guidelines for the nurse for
assessment of the client system
Utilization of the nursing process
Implementation of preventive
interventions
The potential of generating
nursing theories (i.e. theories of
optimal client stability and
prevention as intervention)
(Alligood & Tomey, 2010)
Application in Practice
Interdisciplinary practice
Social workers
Physical therapy
Acute care psychiatric patients
Public health facilities
Adolescent drug rehabilitation centers
Hospital settings
Individuals, families, groups,
communities
Various countries other than the USA
Case Study
Mrs. Loder is a 42 year old woman currently hospitalized for new onset of seizure
disorder after experiencing a headache for three days. She has stable, long term full
time employment in a managerial position. She takes no current medications, is
physically active and has an outgoing personality. She and her husband have lived
within their current neighborhood for more than 20 years and describe their
involvement in the community as very important. . Her only prior involvement with
the health care system was the birth of her son twelve years ago.
Within three days of admission to the hospital Mrs. Loder is diagnosed with
multiforme glioblastoma and undergoes a craniotomy to debulk the tumor. She
requires very little pain medication and has had no further seizure activity.
Medications include Keppra and Decadron which she will continue to take after
discharge. She will have continued treatment including chemotherapy, radiation
and eventual further debulking of her tumor. She and her husband plan to return
home at discharge. Mr. Loder will need to return to work as soon as possible. They
state they are determined to remain positive in their thinking and they have not
informed their son of the extent of the illness. The Loders do not have family locally
but there have been multiple offers of community support. They have declined home
health nursing at this time.
Neuman feels that nurses are unique in that they treat the entire client system and
they will widen their focus of care to include all of the variables that will affect the
clients response to current stressors they are experiencing. The nurses perception
of the clients situation will affect the care that they will provide (Neuman, 2002).
Case Study Questions
1. How would the Loder family be
described in the client system?
2. What is the environment of the
client and how will it affect long
term functioning
3. What interventions would the
nurse best fit into place to help
the client system maintain the
greatest possible stability?
Answers: Case Study
Questions
1. How would the Loder family be described in the
client system?
A. The Loder family will be in the midst of a new
experience. This experience will affect all aspects of
their lives and will have personal, financial, and
interpersonal stressors. There appears to be a close and
supportive interpersonal relationship that will be
ongoing. Mrs. Loder is the primary wage earner and
there will be a significant financial strain placed on the
family. Extended family is not currently available. There
will be a requirement for current and ongoing health
care intervention which is new for this family. Mrs. Loder
may or may not want to continue working, as possible.
Nursing will need to understand their role in providing
support and referrals to other disciplines based on the
family needs.
Answers: Case Study
Questions
2. What is the environment of the client and how
will it affect long term functioning?
A.The environment of this client system is multifactorial.
The family will be experiencing change in the normal
social routine and personal interactions. There will be a
large support group of friends, coworkers and
neighbors. This is positive because there will be many
needs to be met in the coming months and the family
will be able to function independently but also able to
call on the help of others as needed. The negative
aspect of their environment may be the initial
overwhelming need of others to be involved or help
when the family is still in the phase of learning to work
through the new diagnosis and the lifestyle choices they
will make during changes in Mrs. Loders health status.
Answers: Case Study
Questions
3.What interventions would the nurse best fit
into place to help the client system maintain the
greatest possible stability?
A. Nursing should meet the requirement of
immediate care by providing information about
resources the patient and family may need in
the current timeframe. Referrals should be
made to initiate social work availability. Nursing
can help to delineate the current necessary
stressors and the interpersonal stressors which
can be addressed by community nursing and
support groups available to the patient and her
family that will be needed in the future.
References
Betty Neuman's systems model. (2011, February 21). Retrieved
from
http://currentnursing.com/nursing_theory/Neuman.html
Hayman, P., & Wolfe, S. (2000, April). Neuman system model.
In Neuman System Model. Retrieved March 27, 2011, from
http://www.patheyman.com/essays/neuman/index.htm
Neuman, B. (1995). The Neuman systems model (3rd ed.).
Norwalk, CT: Appleton & Lange.
Neuman, B., & Fawcett J. (2002). The Neuman systems model
(4th ed.). Upper Saddle River, NJ: Prentice Hall.
Parr, M. (1993). The Neuman Health Care Systems model-an
evaluation. British Journal of Theatre Nursing, 3(8), 20-27.
Alligood, M., & Tomey, A. (2010). Nursing theorists and their
work
(4th ed.). Maryland Heights, MO: Mosby.