Betty Neumans Systems Model Elizabeth Berkemeier Jaime Ziemba

Betty Neuman's Systems Model Elizabeth Berkemeier, Jaime Ziemba & Lindsey Randstadler

Unique focus of Neuman systems model according to Betty Neuman, (2001) "The Neuman system model reflects nursing's interest in well and ill people as holistic systems and in environmental influences on health. Clients' and nurses' perceptions of stressors and resources are emphasized, and clients act in partnership with nurses to set goals and identify relevant prevention interventions. The individual, family or other group, community or social issues, all are client systems which are viewed as composites of interacting physiological, psychological, sociocultural, developmental and spiritual variables" (p. 322).

What shaped Betty Neuman Born in 1924 on a farm in rural Ohio - this background helped her develop compassion for those in need. Education • 1947 - RN from diploma program in OH • 1957 -BSN, UCLA mental health & public health • 1966 -MSN, UCLA • 1967 -1973, UCLA faculty. • Developed first community mental health program for graduate students at UCLA. • 1985 - Ph. D Western Pacific University-clinical psychology.

History of the Neuman's Systems Model • Developed in 1970 as a teaching tool to integrate four variables of man. • 1974 - published and classified as a systems model called "The Betty Neuman Health-Care Systems Model: A Total Approach to Patient Problems" • Published first book detailing NSM in 1982. Notable change: "patient" now referred to as "client" • The Neuman Systems Model, 2 nd ed. , 1989. Spiritual variable added to diagram as fifth variable. • 3 rd, 4 th & 5 th editions of The Neuman Systems Model published in 1995, 2002 & 2010

Who and what influenced the NSM? • The writings of philospher de Chardin on the wholeness of life. • Marxist Cornu's views on the oneness of man and nature. • Gestalts theories on the interaction between man and the environment. • Von Bertalannfy's, Emery's and Lazarus' views on systems. • Selye's concept of stress and Caplan's levels of prevention. Fawcett, J. (2001). The nurse theorists: 21 st-century updates-Betty Neuman. Nursing Science Quarterly, 14(3), 211 -214.

More on the origins of NSM (Neuman, 1995) "The development of the wholistic systemic perspective of the Neuman systems model was motivated by my own basic philosphy of helping each other live, many diverse observations and clinical experiences in teaching and encouraging positive aspects of human variables in a wide variety of community settings, and theoretical perspectives and stress related to the interactive, interrelated, interdependent, and wholistic nature of systems theory. The significance of perception and behavioral consequences [also] cannot be overestimated" (p. 675 -676) Neuman, B. (1995). The Neuman systems model (3 rd ed. ). Norwalk, CT: Appleton and Lange.

Key Concepts of the Neuman Systems Model Each client system is made up of 5 variables • Physiological variables o bodily structure & function • Psychological variables o mental processes & relationships • Sociocultural variables o social & cultural funtions • Developmental variables o developmental processes of life • Spiritual variables o continuum of spirituality - from complete unawareness to full spiritual understanding.

Client system as a core Flexible line of defense: -The outermost ring of defense, prevents invasion Lines of of stressors. resistance core Normal line of defense: - Represents the client Flexible systems normal or usual line of wellness state. defense Lines of resistance: - Involuntarily activated Normal line when a stressor invades of defense normal line of defense.

Environment and Stressors Internal environment-all forces or influences internal to or contained within the boundaries of the defined client system, the source of intrapersonal stressors. External environment-all forces or influences external to or outside the client system, the source of interpersonal and extrapersonal stressors. Created environment-subconsciously developed by the client as a symbolic expression of system wholeness. Acts as a safety mechanism to block the reality of the environment and health experience. Supercedes the internal and external environments.

Variance from wellness & illness according to Betty Neuman http: //www. neumansystemsmodel. org/NSMdocs/nsm_powerpoint_overview. h tm Variance from wellness Illness • Varying degrees of system instability. • The difference from the usual or normal wellness condition. • Illness is a state of insufficiency with disrupting needs unsatisfied • 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

Nursing implications of the NSM Neuman's Systems Model Nursing Process Format 1. Nursing diagnosis: �determined on the basis of assessment of the variables and lines of defense and resistance that make up the specific client system. 2. Nursing goals: �determined with the client for desired prescriptive changes to correct variances from wellness. 3. Nursing outcomes: Nursing interventions are implemented using one or more of the prevention as intervention methods.

How it's done: Prevention as Intervention • Primary prevention as intervention- nursing actions o preventing stressor invasion; providing resources to retain or strengthen existing client/client system strengths; supporting positive coping and functioning; motivating the client system toward wellness; educating the client system • Secondary prevention as intervention-nursing actions o • protecting the client system's basic structure; mobilizing and optimizing the client system's internal and external resources to attain stability and energy conservation; facilitating purposeful manipulation of stressors and reactions to stressors; motivating, educating, and involving the client system in mutual establishment of health care goals; facilitating appropriate treatment and intervention measures Tertiary prevention as intervention-nursing actions o attaining and maintaining the highest possible level of client system wellness and stability during reconstitution; educating, reeducating, and/or reorienting the client system as needed; supporting the client system toward appropriate goals; coordinating and integrating health services resources; providing primary and/or secondary preventive intervention as required. The nurse evaluates the outcome goals by: confirming attainment of outcome goals with the client system and reformulating goals as necessary with the client system

Fig. 1 "A total person approach to viewing patient problems" (Neuman and Young, 1972)

Global Concepts Human being- The client. Viewed as a whole, dynamic. Individuals interact with their environment, and everything in the environment relates to the individual. Environment- Both external and internal. Environment is dynamic, and this influences the client. Health- The result of clients interaction with their environment. Maintained by lines of defenses within the client. Nursing- Focuses on all aspects of life and problem solving for clients using one of three levels of prevention while viewing the client as an integrated being. (Bott, Duke, Marett & Memmott, 2000)

What's the point? Was she just another hippie? Neuman System Model grew out of a movement in the 1970's and 1980's that began to recognize the patients as whole systems. With the growing complexity of medicine, health care became more fragmented (Bott, et al). This is where Betty comes in. Her views were shaped by the emerging health care practices at the time, which included taking a broader look at patients and their needs. Also around this time the hospice movement took place. Neuman System Model has been criticized for being to complicated, broad and abstract. With increasing complexity of our health and managing major illnesses, this model is becoming more relevant in the 21 st century (Bott, et al).

So what do we do with it? Neuman System Theory has a way of mashing all the global concepts together. You really have to look at the individual situation to define the concepts for that specific situation. They will change every time; they are dynamic. This model can be used for any situation at any given time. It is broad and abstract, but relevant and applicable. This system seems to be particularly useful for hospice and case management nursing. It is well suited to not only serve an individual client, but also families, groups and communities because of its adaptability.

Nursing and Beyond Betty Neuman's theory was designed for nursing, but now other parts of the interdisciplinary health care team are beginning to use her model Members of the interdisciplinary health care team may include: § physicians § physical therapy § occupational therapy § respiratory therapy § speech therapy § psychologists § lab, x-ray

What/Who Influenced Betty Neuman? The influences of this model are deeply rooted in both philosophy and psychology as they pertain to client health and well being The influences of Betty Neuman were: § Pierre Tielhard de. Chardin § Gestalt Theory § General Adaptation Syndrome § General Systems Theory

Are the Global Concepts Represented? The overall contributions of the model to the discipline of nursing are summarized by Neuman: § "The Neuman's System Model fits well with the wholistic concept of optimizing a dynamic yet stable interrelationship of spirit, mind, and body of the client in a constantly changing environment and society" (Neuman & Young, 1972).

Narrow View? Betty Neuman designed her model around the idea that it is universal and can be adapted to many situations involving a client and the client's stress and their reaction to it. This model can be used in the OB and OR situation. The client, as well as their families, have much stress in both situations. The nurse will be able to implement the three levels of prevention: 1. Protects the normal line and strengthens the flexible line of defense 2. Strengthens the internal lines of resistance 3. Readapt, stabilizes, and protects the client's return to wellness after treatment

Practice Situation #1 Below are slides in which the Neuman model was used by a nurse to care for a client. The information was taken from nursingtheories. blogspot. com/2008/07/betty-neumans. html • About a week ago I had in my care the wife of the captain of the ill-fated Princess of the Stars. In this case, I was able to identify the following stressors: 1. Psychological-Emotional: Anxiety which stemmed from the uncertainty about the fate of her husband. A sense of guilt because relatives of the passengers are blaming her husband for the tragedy. Ambivalence in the sense that she would be happy if her husband survived and at the same time worried too that if he did survive he would be subjected to court litigation. 2. Financial Stress: Her husband is the breadwinner of the family and in a brood of 5 children, only one is employed; the rest are still in school. 3. Physical Stress manifested as: a. Insomnia b. Elevated blood pressure unresponsive to maintenance medications c. Persistent chest pains (continued on next slide)

Practice Situation #1 Nursing interventions are carried out on three preventive levels: • Primary Prevention would not be applicable because the accident causing the stressors has already occurred and the patient has already developed the reactions/symptoms of stress. • Secondary Prevention is applicable in this case. Because of the persistent elevated blood pressure ( above 200/110) accompanied by severe chest pains, the patient was admitted to the hospital for both diagnostic and therapeutic management. Nursing intervention centered initially on the round the clock monitoring of the blood pressure and giving of the ordered anti- hypertensive drugs. Since the EKG showed ischemia, the patient was closely watched for worsening of the pain because of the possibility of a myocardial infarction. Immediate referral of the patient to the resident physician is to be made if chest pain persisted despite giving isosorbide dinitrate for proper evaluation. Aside from giving anxiolytics to decrease the anxiety of the patient, I have to warn visiting relatives to refrain from talking about the tragedy. Sedatives were given before bedtime to prevent insomnia. • Tertiary Prevention: Upon discharge, I gave the patient and the immediate family members the following advice: 1. If possible to stay in a relative’s house for a few weeks because they were being hounded by media who were camped outside their home. 2. Regular monitoring of the patient’s blood pressure by a daughter who is a student-nurse who should also monitor her intake of medications as prescribed by the physician. 3. Avoid watching TV shows that mention about the tragedy. 4. Avoid answering the phone. 5. She should have a close relative with her aside from the children who will manage their affairs in the meantime.

Practice Situation #2 In the Community. . . In one of the rotations of my students in the community, we encountered this very interesting newly married young couple (both are 18 years old). They have been married only for 3 months, but the supposed to be happy pair is already facing a lot of stressors. One condition that brings extrapersonal stress is the unemployment of the husband. Their financial source is not enough to meet their needs. The woman somzd enough for her son. This relationship poses as an interpersonal stress to her. The wife is also pregnant at that time, and her poor nutritional (underweight) and emotional status (sadness and anger at her mother-in-law) create intrapersonal stresses. We know, based on Neuman’s Systems Model, that the reaction to stressors would depend on the strength of the lines of defense. The woman, due to financial constraints, is suffering from poor nutritional status. She usually lacks enough sleep due to the nature of her work. This creates a breach to her flexible line of defense. The normal line of defense also becomes unreliable because of her uncaring attitude toward her pregnancy and sexual behaviors that predispose her to a lot of possible illnesses. Her coping abilities are also affected because she is sometimes preoccupied with her relationship problems with her mother-in-law.

Practice Situation #2 These conditions put not only our client but also her unborn child on the verge of developing various illnesses. Hence, our interventions focused on restoring system stability, by helping the client’s system adapt to the stressors. Starting with primary prevention, we tried to educate their family on the importance of having good nutrition. We suggested some nutritious but cheap food choices. We also tried to advice her on possible alternative jobs that would not jeopardize her health and that of her unborn baby. For the secondary prevention, we advised that she seek pre-natal check-up, and make use of the available services of the nearby health center. ( After about 1 month of constant visits to these clients, we really observed noticeable improvements in their health conditions. The woman began to show weight gains consistent with her age of gestation. The couple has also learned to plant and eat nutritious food such as fruits and vegetables. The husband started to work as a production operator in a nearby factory, allowing his wife to take a break from her old job. Before our duty in the community ended, we were able to initiate tertiary prevention by supporting and commending the positive behavioral changes exhibited by the couple. We also dwelt on strengthening the positive attributes of the family, such as their unwavering faith in God, and their strong devotion to each other. We learned from this experience that no problem is unsolvable with the use of consistent and wellcontemplated nursing care.

Case Study Sally, a nurse for community mental health is caring for 3 clients today. First, she meets Sam has been admitted to a psychiatric unit with a diagnosis of psychosis and schizophrenia. Sally provides Sam with appropriate interventions to help stabilize his condition, monitors his compliance with medication and conducts therapy sessions. 1. Sally is using what level of prevention according to the Neuman Systems Model? 2. Give a few examples of nursing actions using Tertiary preventions as interventions.

References Bott, R. , Duke, L. , Marett, K. , Memmot, R. (2002). Use of the Neuman Systems Model for interdisciplinary teams. Online Journal of Rural Nursing and Health Care. 1(2) 35 -43. Fawcett, J. Appendix N 1: Conceptual models and theories of nursing. (n. d. ). In Tabers Cyclopedic Medical Dictionary Retrieved from STAT!ref. Kozier, B. et. Al (2004). Fundamentals of. Nursing: Concepts, Process, and Practice (4 th ed. ) New Jersey: Pearson Marriner-Tomey, A. (1994). Nursing Theorists and Their Work (2 nd edition). St. Louis: Mosby Neuman, B. , & Fawcett, J. (Eds. ). (2011). The Neuman systems model (5 th ed. ). Upper Saddle River, NJ: Pearson.

References(cont. ) Neuman, B. , & Young, R. J. (1972). A model for teaching total person approach to patient problems. Nursing Research 21, 264 -269. Fig. 1: http: //nursing. jbpub. com/sitzman/art/Betty%20 Neuman%27 s%20 Syst ems%20 Model. jpg

Links http: //nursing-theory. org/nursing-theorists/Betty. Neuman. php www. rno. org/journal/index. php/onlinejournal/article/view. File/76/73 nursingtheories. blogspot. com/2008/07/betty-neumans. html http: //www. neumansystemsmodel. org/ http: //currentnursing. com/nursing_theory/application_Betty _Neuman's model. html