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Neuman’s Systems Model. Presented By Prof. Dr. Nefissa A. Kader Vice Dean of Education and Student Affairs & Professor of Psychiatric Mental Health Nursing. Objectives. By the end of this presentation, each candidate will be able to:
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Neuman’s Systems Model Presented By Prof. Dr. Nefissa A. Kader Vice Dean of Education and Student Affairs & Professor of Psychiatric Mental Health Nursing
Objectives By the end of this presentation, each candidate will be able to: • Identify origin of the conceptual model (Historical evolution of the model, author motivation, influences of author thinking, philosophical claims, assumptions, strategies for knowledge world view). • Be acquainted with the unique focus of the conceptual model. • Be acquainted with the four concepts of nursing metaparadigm and their relationships.
History of model development • Betty Neuman was born in 1924 ,Ohio. • Her model originally developed in 1970 at the University of California, Los Angeles as teaching aid. • It is developed as a way to teach an introductory nursing course to graduate nursing students “a model for teaching total person approach to patient problems”. • The goal of the model was to provide a wholistic overview of the physiological, psychological, Sociocultual, and developmental aspects of human beings.
History of model developmentCont’d. • After a two-year evaluation of the model, it was published in Nursing Research (Neuman & Young, 1972). • Neuman has since published three editions of the Neuman Systems Model. • The Neuman Systems Model Trustees Group was established in 1988. • This group was established for the perpetuation,preservation, and protection of the integrity of the model and any future changes in model must have the consent of the trustees (George, 1996).
Influences Neuman’s model was influenced by a variety of sources, but most particularly: • The philosophy of writers such as: • Pierre Dechardin • Bernard Marx • Gestalt theory • General Adaptation Syndrome • General systems theory
Influences cont’d. Pierre Dechardin • Was a Catholic priest and scientist who is credited with first proposing the idea of spiritual evolution. • He believed that spiritually, humans are evolving toward an ultimate perfection that he called the Omega Point. • He is most often associated with the idea of a mind, the interconnectedness of human spirit and mind.
Influences cont’d. Bernard Marx • Marxist philosophy suggests that the properties of parts are determined partly by the larger wholes within dynamically organized systems. • Human activities is the product of a particular social and economic environment. • Societies should be reorganized in a more equitable way to eliminate poverty.
Influences cont’d. Gestalt Theory • Is a theory of German origin. • It centers around the concept of the Gestalt or the whole. • It emphasizes that the human world of experience is the only immediately given reality. • The dynamic interaction of the individual and the situation determines experience and behavior (meaning that no two interactions will ever be the same and we should not simplistically over generalize).
Influences cont’d. General Adaptation Syndrome • It postulates that there is a nonspecific response to stress involving three stages: • Alarm. • Resistance. • Exhaustion. • In the first stage, the body gears up in preparation to deal with the stressor. • In the second stage, the body seeks to return to homeostasis- a resting state. • If stressors are not removed, then the body will not return to homeostasis, but will enter the third stage, exhaustion, in which the body function begins to breakdown.
Influences cont’d. General Systems Theory • Grew out of the field of Thermodynamics, a branch of physics, chemistry and engineering. Thermodynamics is the study of the flow of energy from one system to another. • It posits that the world is made up of systems that are interconnected and are influenced by each other; systems can also be concentric with smaller systems forming a larger system. • Two key assumptions are that energy is needed to maintain a high organizational state and that a dysfunction in one system will affect other systems, particularly if the dysfunctional system is a subsystem of a larger system.
Philosophical Claims Neuman has represented the philosophical claims in the form of a basic philosophy, beliefs about: • Holism: she believes in holism which she spelled with a “W” in her 1989a, 1989d and 1990a publications. • Reality, wellness and the person • Basic assumptions about the person, the environment and the nursing. • Her basic philosophy is “helping each other live”
Underlying Assumptions The basic assumptions have not changed significantly, but have been more clearly articulated. These statements are paraphrased below: • Each client or client system is unique, with composite innate characteristics, and possesses a normal range of responses. • The client as a system constantly exchanges energy with environment. • There are many types of known, unknown, and universal stressors that may upset a client’s equilibrium (normal line of defense). The interrelationship of the five client variables determines the degree of protection offered by the flexible line of defense. • Over time, each individual client system develops a normal range of responses called the client’s normal line of defense. • The cushioning, accordion-like flexible line of defense protects the client system equilibrium and interrelationships among the five variables system energy.
Underlying Assumptions cont’d. • Wellness is a dynamic composite of the interrelationship of the five client variables and represents a continuum of variable system energy. • Following a stressor reaction, internal resistance lines attempt to stabilize the client by returning to normal or enhanced wellness state. • Primary prevention assessment and intervention identifies and allays risk factors associated with stressors. Included in primary prevention is health promotion. • Secondary prevention relates to symptom identification and implementation of preventions to deal with system disruptions. • Tertiary prevention assists client adjustment as reconstitution is initiated and maintenance factors move the client back toward primary prevention
Strategies for knowledge development The Neuman systems Model arose from Neuman observations, her clinical and teaching experience in mental health nursing and her synthesis of knowledge from several disciplines. She used both inductive and deductive strategies.
World View • The Neuman systems Model reflects the reciprocal interaction world view. • Neuman views the client system as active, she characterized client-system environmental exchanges as reciprocal and noted that “both client and environment my be positively or negatively affected by each other (1989). • Neuman’s holistic, multidimensional approach (1990) also reflects the reciprocal interaction world view.
World View cont’d. • Resistance and change are linked in Neuman’s statement that a system implies dynamic energy exchange with the environment, moving toward or away from stability. • The reaction world view is also evident in her use of Selye’s mechanistic theory of stress and adaptation. • The mechanistic view is evident in NSM by using Selye’s theory of stress (Stimuli- response).
Unique focus of the Model • The unique focus of the Neuman’s systems model is the wellness of the client/client system in relation to environmental stress and reactions to stress. • The Neuman's model has always been classified as a systems model. • The model addresses environment in detail with descriptions of the internal, external, and created environments. The internal and external environments are regarded as the sources of stressors that influence the client system.
Unique focus of the Model cont’d. • The lines of defense and resistance form boundaries between the central core of the client system and their environments. • The outer boundary for the client as a system. • Neuman referred to the client system-environment interaction as a dynamic equilibrium, commenting that “a dynamic equilibrium should excite within the system-stability implies state of balance requiring energy exchange between the system and environment to cope with imposing stressors”.
Key Concepts • WHOLISTIC CLIENT APPROACH: The Neuman system model is a dynamic, open, system approach to client care. It is originally developed to provide a unifying focus for nursing problem definition and for best understanding the client in the intervention with environment.
Key Concepts cont’d. • WHOLISTIC : Clients are viewed as wholes whose Parts are in dynamic interaction. • OPEN SYSTEM: • A system is open when its variables are exchanging information and energy within its complex organization. • Stress and reaction to stress are the basic components of an open system.
Key Concepts cont’d. • ENVIRONMENT: Internal and external forces affecting and being affected by the client at any time within environment. • CREATED ENVIRONMENT: It is the client’s unconscious mobilization of all system variables toward system stability, Integration, and integrity.
Key Concepts cont’d. • INPUT AND OUTPUT: The matter, energy and information exchanged between client and environment, which is entering and leaving the system at any point in time. • PROCESS OR FUNCTION: The exchange of the matter, energy and information with environment and interaction of the parts and Subparts of the system of client.
Key Concepts cont’d. • Feedback: The process within which the matter, energy, and information as system output provides feedback for corrective action to change, enhance or stabilize the system. • STABILITY: The client or a system successfully copes with stressors; it is able to maintain an adequate level of health.
Key Concepts cont’d. • WELLNESS exists when the parts of client system interact in harmony. • Illness is disharmony among the variables of client system. • STRESSORS are capable of having either a positive or negative effect on the client system.
Key Concepts cont’d. • A stressorit is any environmental forcewhich can potentially affect the stability of the system: they may be: • Intrapersonal -occurs within person, e.g. emotions and feelings • Interpersonal -occurs between individual’s system boundary and one or more other system e.g. role expectations • Extrapersonal -occurs outside the individual, e.g. job or finance pressures
Key Concepts cont’d. FLEXIBLE LINES OF DEFENSE The flexible line of defense is the outer barrier to the normal line of defense, the line of resistance, and the core structure. If the flexible line of defense fails to provide adequate protection to the normal line of defense, the lines of resistance become activated.
Key Concepts cont’d. Normal Line of Defense Represents system stability over time. It is considered to be the usual level of stability in the system.The normal line of defense can change over time in response to coping or responding to the environment. LINES OF RESISTANCE The lines of resistance protect the basic structure and become activated when environmental stressors invade the normal line of defense
Key Concepts cont’d. THE BASIC STRUCTURE: consists of all variables as survival factors common to man. DEGREE OF REACTION: is the amount of system instability resulting from stressors. RECONSTITUTION is the state of adaptation to stressors in the internal and external environment.
Key Concepts cont’d. PREVENTIONis the primary nursing intervention. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the client. • Primary prevention occurs before the system reactsto a stressor. On the one hand, it strengthens the flexible line of defense. On the other hand manipulates the environment to reduce or weaken stressors.Primary prevention includes health promotion and maintenance of wellness.
Key Concepts cont’d. • Secondary prevention occurs after the system reacts to a stressor.Secondary prevention focuses on preventing damage to the basic structure 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. Tertiary prevention offers support to the client and attempts to add energy to the system in order to facilitate reconstitution.
NURSING METAPARADIGM The four metaparadigm concept explicitly or implicitly present in Neuman and all nursing models are………. 1- 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. 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.
Nursing cont’d. • Neuman believes that nurses should serves as coordinators of health care for clients. • Through purposeful interventions, nursing can help individuals, families and groups to “ retain, attain, and maintain a maximum level of optimal system wellness (Neuman 1989, 1995, 2001). • The nurse in Neuman's model is seen as an intervener whose goal is either to reduce the client’s encounter with certain stressors or to implement an appropriate intervention within the three levels of prevention (1989):
Nursing cont’d. • At the primary preventionlevel the nurse helping the client to strengthen his or her ability to respond to the stressor (through interventions that expand the flexible line of defense and thereby help the client retain system stability). • Health promotion is a component of this level of prevention. (Neuman, 1989, 1995, and 2001). • Secondary prevention interventions are appropriate when a stressor reaction occurs and are aimed at treatment of symptoms. • The outcomes of such interventions are strengthen lines of resistance that protect the basic client structure and help the client to attain system stability.
Nursing cont’d. • After a stressor reaction occurs and some degree of system stability is achieved, Tertiary prevention interventions are appropriate to help the client to reconstitute and maintain the current level of wellness. • The nursing process within the Neuman model consists of three components: nursing diagnosis, goals, and outcomes.
Neuman envisions a 3-stage nursing process • Nursing Diagnosis - based of necessity in a thorough assessment, and with consideration given to five variables (physiological, psychological, socio-cultural, developmental and spiritual) in these stressor areas. • Nursing Goals - these must be negotiated with the patient, and take account of patient's and nurse's perceptions of variance from wellness. • Nursing Outcomes - considered in relation to five variables, and achieved through primary, secondary and tertiary interventions.
NURSING METAPARADIGM 2-Person • Neuman’s definition of a person was originally as physiological, psychological, socio-cultural, spiritual and developmental being. • The concept of person in the Neuman is called client or client system. • The client whether an individual, group, community or social system, is a dynamic composite of interrelationships between Physiological, Psychological, Socio-cultural, Developmental and Spiritual variables, and basic structure variables (Neuman, 1989, 1995, and 2001) • Clients are composed of a basic structure of survival factors inclusive of the five client system variables and surrounded by various lines of defense and resistance.
Person cont’d. • The client possesses various lines ofdefense and resistance and is viewed as being engaged in varying amounts of activity in relation to stress. • Stressors or reactions occur when the flexible line of defense has failed to protect or support the normal line of defense that is considered the client’s usual stability state. • One’s normal life of defense represents the client’s ability to adjust to daily environmental stressors. • Protecting the normal line of defense and serving as the outer boundary of the client’s system is the flexible line of defense.
Person cont’d. The person is a layered multidimensional being. Each layer consists of five person variables or subsystems: • Physiological - refers of the physiochemical structure and function of the body. • Psychological - refers to mental processes and emotions. • Sociocultual - refers to relationships; and social/cultural expectations and activities. • Spiritual - refers to the influence of spiritual beliefs. • Developmental - refers to those processes related to development over the lifespan
NURSING METAPARADIGM 3-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. These forces include the intrapersonal, interpersonal and extrapersonal stressors which can affect the person's normal line of defense and so can affect the stability of the system. • The created environment is another example of Neuman's effort to delineate the holistic concept approach of the model in addition to spirituality
Environment cont’d. • The created environment is unconsciously developedby the client when a threat to the basic structure or system function exists (Neuman, 1989, 1995, and 2001). • Therefore, created environment can serve to protect the client from intera-, inter-, and extrapersonal stressors and thereby function to maintain system stability by changing the response to environmental stressors (Neuman, 1989, 1995, and 2001).
Environment cont’d. 3-Environment cont’d.: Stressors occur within internal and external environment and are classified as being intra, inter, or extrapersonal in nature. • Intrapersonalstressor…occurs within boundary of client system. • Interpersonal stressor… occurs between client system boundary and one or more other client system. • Extrapersonal stressor… forces occur outside client system boundary.
NURSING METAPARADIGM 4-Health: • Is viewed as a continuum running from greatest negentropic state (wellness) to greatest entropic state ( illness). • It is a condition determine by the degree of harmonious arrangement of the five client variables and the basic structure factors and is reflected in the client’s level of wellness. • 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)".
NURSING METAPARADIGM 4-Health cont’d.: • 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. • The degree of client wellness is determined by the amount of energy required to retain, attain or maintain system stability.
Propositions • Neuman (1974) presented the assumptions that she identified as underlying the “Systems Model. she has now labeled these as propositions (Neuman, 1995). • Each individual has a basic energy resource structure which contains characteristics both unique and common to all human kind, and is essential to life. • Man is a composite of the interrelationships of the four variables (Physiological psychological, socio- cultural, and developmental) which are at all times present.
Propositions • Each individual has a normal line of defense which is that person’s dynamic state of adaptation or (homeostasis) which has evolved and been maintained over a period of time. This is unique for each individual person normal state of wellness. • Each individual has a flexible line defense which is constantly changing in response to single / multiple variables and stressors (biological, socio-cultural, and developmental).
Propositions • Stressors are both universal and known; some are unique to the client. They have potential to disturb equilibrium, thus causing a change in priority of needs at any given moment. • The degree of client reaction to stressors depends on the resistant factors encountered by the stressors and the interrelationship of variables. • Each person has an internal set of resistance factors. Lines of resistance function is to stabilize and return the client to the state of normal line of defense. • Primary prevention relates to general knowledge applied to client assessment in an attempt to identify stressors before they occur.
Propositions • Secondary prevention relates to symptomatology following these are intervention generally initiated after an encounter with a stressor. • Tertiary prevention relates to the adaptive process as reconstituted begins and moves back toward primary prevention. These are intervention initiated after treatment.
