Betty Neuman’s Health Care Systems Model Team Saturn Ralph Quinones RN Karen Roy RN NRS430 Grand Canyon University February 2009
Content • Overview of Neuman’s Health Care Systems Model • Client System Concept Model • How Neuman’s Health Care Systems Model Views the Four Metaparadigm • Three Ways Neuman’s Health Care Systems Model Could be Used to Improve Nursing Practice • Neuman’s Systems Model Concept Map
Overview of Neuman’s Health Care Systems Model • Published in 1972 as “A Model for Teaching Total Person Approach to Patient Problems” in nursing research (currentnursing.com/nursing_theory,2009). • The goal is to provide a holistic overview of human beings (patheyman.com, 2009). • The focus is the client system and the interaction of this system with the environment (Newman,2005).
Overview of Neuman’s Health Care Systems Model • Purpose of nursing action is to best retain, attain and maintain optimal client system health or wellness using the three preventions as intervention to keep the system stable (Hood & Leddy, 2006, p. 156). • Focuses on stress reduction and addresses how stress, and the individual’s response to it affects the development, maintenance, and restoration of health (Hood et al., p. 112). • Client stability depends on the depth of stressor penetration into the client system (Hood et al., p. 156).
Client System • A Client system consists of multiple layers & a central core: Central core- basic structure and energy reserves. Flexible lines of defense- adaptive responses that fluctuate and protect from stressor penetration Normal lines of defense- conscious adaptation response that fluctuate and protect the core form stressors. Lines of resistance- protection factors activated when stressors have penetrated the normal line of defense, usually unconscious in nature. (Hood et al., p. 113)
Client Stressors • Stressors may be positive or negative, and of three types: Intrapersonal- arising from within the person. Interpersonal- arising between two or more persons. Extrapersonal- arising from the external environment. (Hood et al., p. 113)
How Neuman’s Health Care Systems Model Views the Four Metaparadigm The four metaparadigm are: • Person or persons (the recipient of nursing care) • Environment (physical and social) • Health (a process or state) • Nursing (goals, roles, and functions) (Hood et al., p. 106)
Metaparadigm One: Person • Person or client system can be individuals, families, groups, & communities (Hood et al., p.113). • A composite of physiological, psychological, sociocultural, developmental, & spiritual variables in interaction with the internal and external environment (Hood et al., p.114)
Metaparadigm Two: Environment 2. Environment includes all internal and external factors of influences surrounding the identified client or client system (Hood et al., p.114). Internal environment – Within the human body. External environment – Outside the human body. Created environment – Client perceptions of the internal and external environments (Hood et al., p.113).
Metaparadigm Three: Health 3. Health is a continuum of wellness to illness. Wellness- dynamic equilibrium of the normal line of defense, where stressors are successfully overcome or avoided by the flexible line of defense. Illness- state when a stressor breaks through the normal line of defense and causes a reaction with client system’s line of resistance (Hood et al., p. 113)
Metaparadigm Four: Nursing 4. Nursing is prevention as intervention. Primary- Interventions to promote health. Secondary- Occurs once a stressor penetrates the normal lines of defense or lines of resistance. Tertiary- Restoration of balance (rehabilitation). (Hood et al., p. 113)
Three Ways Neuman’s Health Care Systems Model Could be Used to Improve Nursing Practice • Emphasize the client within the system perspective, holistically, and multi-dimensionally. • Utilized in nursing education at all entry levels (diploma, associates, and baccalaureate). • Nursing research: Project a role for nursing during catastrophic events at the local community, city, county, state, interstate, national and global levels.
1.Emphasize the Client Emphasize the client within the system perspective, holistically, and multi-dimensionally. • Treating the client system and not just the diagnosis allows implementation of the model into nursing practice, therefore, allowing nurses to retain, attain and maintain optimal client system stability by initiating the three layers of prevention as intervention, and reducing the effects of stressors (Hood et al., p.156).
2. Utilized in Nursing Education Utilized in nursing education at all entry levels (diploma, associates, and baccalaureate). The model assists students to carry out in-depth assessments, categorize comprehensive data, and plan specificinterventions with clients as holistic beings (SLSU, 2008).
2. Utilized in Nursing Education Students who could envision the connection between Neuman’s Model and North American Nursing Diagnosis Association (NANDA) nursing diagnosis through the nursing process would be better able to choose appropriate nursing diagnoses for client care (McHolm & Geib, 1998).
2. Utilized in Nursing Education Neuman envisions a three stage nursing process: • Nursing Diagnosis- based of necessity in a thorough assessment, and with consideration given to five holistic variables in three stressor areas. • Nursing Goals- these must be negotiated with the patient, and take account of patients’ and nurse’s perception of variance from wellness. • Nursing Outcomes- Considered in relation to 5 holistic variables, and achieved through primary, secondary, and tertiary interventions (NT, 2009).
3. Nursing Research Nursing research: Project a role for nursing during catastrophic events at the local community, city, county, state, interstate, national and global levels. Fawcett (2001) studied two hundred published literatures integrating the Neuman model and concluded that the majority of researchers were focusing on prevention and interventions.
3. Nursing Research Researchers are using this model to determine appropriate interventions to strengthen the lines of resistance to prevent further dysfunction within community systems (Stanhope & Lancaster, 2003).
3. Nursing Research Example 1: Flu epidemic at state client system level. Primary intervention- vaccination of at risk groups Secondary intervention- mass flu vaccination for all whom wish. Tertiary intervention- flu vaccination predicted to be reduced related to limited resources. Implement interstate and national resources to re-supply the lines of resistance and defense before further penetration of stressors occur.
3. Nursing Research Example 2: Current financial meltdown results in 533,00 jobs lost in 11/2008 (Bernstein & Shierholz, 2008). • Research on communities losing a major source of employment to identify stressors and to devise interventions to maximize client system stability. • Over time, chronic health problems develop because of these stressors and lead to poor nutrition, postponement of medical care, and depression (Stanhope & Lancaster, 2003). Ultimately a chronically ill community could result.
References Bernstein, J., Shierhoz, H., (2008). Economic Policy Institute: Job losses accelerate at alarming rate in November. Retrieved January 20, 2009, from the World Wide Web: http://epi.org/publications/entry/webfreatures_econindicators_jobspict_20081205/ Fawcett, J., (2001). Neuman Systems Model-Based Research: An Integrative Review Project.Retrieved January 19, 2009, from the World Wide Web: http://nsqpub.com/cgi/content/abstract/14/3/231 Hood, L. J., & Leddy, S. K. (2006). Conceptual Bases of Professional Nursing (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. McHolm, F., Geib, K., (1998). Application of the Neuman systems model to teaching health assessment and nursing process. Retrieved January 20, 2009, from the World Wide Web: http://findarticles.com/p/articles/mi_qa3836/is_/ai_n8792656 Neuman Systems Model. (n.d). Retrieved January 17, 2009 from http://www.patheyman.com/essays/neuman Newman, D. (2005). Complex patient needs: Nursing models can help! Journal of Christian Nursing, 22(1), 33-38. Nursing Theories: A companion to nursing theories and models. (2009). Retrieved on January 19-20, 2009 from http://currentnursing.com/nursing_theory/application_Betty_Neuman’s_model.htm Southern Luzon State University, (2008). Theoretical Foundations of Nursing: Betty Neuman (System Model in Nursing Practice). Retrieved January 19, 2009, from the World Wide Web: http://slsu-coam.blogspot.com/2008/09/betty-neuman-system-model-in-nursing.html Stanhope, M., Lancaster, J., (2003). Community & Public Health Nursing(6th ed.). St. Louis, MO: Elsevier Health Sciences