Betty Neuman (System Model in Nursing Practice)

Betty Neuman
System Model in Nursing Practice
(1924 - present)

“Health is a condition in which all parts and subparts

are in harmony with the whole of the client.”

Life Story

Betty Neuman was born in 1924 on a farm near Lowell, Ohio.

Her father was a farmer and her mother was a home maker. She grew up in the rural Ohio where she developed love for the land and her compassion for people in need.

1947, Neumans initial nursing education was completed with double honors at People's Hospital School of Nursing (now General Hospital) in Akron, Ohio.

She then moved to Los Angeles to live with relatives in California, she worked in variety of nursing roles that include hospital staff and head nurse, school nurse, and industrial nurse.

She was also involved in clinical teaching in University of Southern California Medical Center, Los Angeles in the areas of medical surgical, communicable disease and critical care.

She had always been interested in human behavior.

She attended the University of California at Los Angeles (UCLA) with a double major in Public Health and Psychology. She completed her Baccalaureate Degree with Honors in Nursing in 1957.

A very supportive and loving wife who helped established and managed her husband's medical practice.

1966, she received her Master's Degree in Mental Health, Public Health Consultation from UCLA.

1985, She- received a Doctoral Degree in Clinical Psychology from Pacific Western University in 1985.

Neuman and Donna Aquilina were the first two nurses to develop the nurse counselor role within Los Angeles based community crisis centers.

She developed her first explicit teaching and practice model for mental health consultation m the late 1960s before the creation of her systems model. Neuman was a pioneer of nursing involvement in mental health. She developed taught, and refined a community mental health program for postmasters level nurses at UCLA.

Books and Publications
Neuman designed a conceptual model for nursing in 1970 in response to request from UCLA graduate students who wanted a course emphasizing breadth rather than depth in understanding the variables in nursing. Initially, the model was developed to integrate students' understanding of client variables that extend nursing beyond the medical model. The Neuman model included such behavioral science concepts as problem identification and prevention. Neuman first published her model in 1972.
She spent the following decade further defining and refining various aspects of the model in preparation for her book, the Neuman System Model: Application to Nursing Education and Practice. Further development and revisions of the model are illustrated in the second (1989) and third (1995) editions. Neuman stated that the fourth edition will offer an integrative review of use of the model with guidelines for application of the model in practice, research, education and administration.

She is a Fellow of the American Association of Marriage and Family Therapy.
She contuse in active, private practice as a licensed clinical marriage and family therapist, with an emphasis on Christian Counseling. Neuman lives in Ohio and maintains a leadership role as Director of Neuman Systems Model Trustees Group, Inc. until 2009.
She serves as a consultant internationally for nursing schools theory-based practice.


Theoretical Sources

1. Gestalt theory - homeostasis process.

2. Marx - properties of parts are determined partly by the larger wholes.

3. de Chardin - philosophy of wholeness of life.

4. Han Selye - General Adaptation Syndrome and Stress Theory.

5. Caplan - prevention levels of nursing.

Metaparadigm in Nursing
- the concept of a whole person and an open system approach.

The concept is aimed towards the development of a person in a state of wellness having the capacity to function optimally by adaptation with environmental stimuli causing illnesses back to a state of wellness

Nursing
Neuman believes that nursing requires a holistic approach that considers all factors affecting a client's health—physical, physiological, psychological, mental, social, cultural, developmental and spiritual well-being.

Person
Neuman regarded the concept of a person as an individual family community or the society.
She sees a person as an open system that works together with other parts of its body as it interact with the environment.

Open system is characterized by the presence of an exchange of information and
reaction with other factors surrounding a person.

Health
Neuman considers health as dynamic in nature in which the person’s health is as the level of health continuum—wellness or illness.

Wellness exists when all the part or system of person works harmoniously.

Environment
The environment can be an internal and external.
Stressors are the forces created by the environment. Stressors are tensions that produce alterations in the normal flow of the environment. These stressors can be:
1. Intrapersonal - occurs within the self and comprises of man as a psycho-spiritual being
2. Interpersonal - occurs between one or more individual and consists of man as a social being
3. Extrapersonal - occurs outside the individual and may include environmental factors

System Model in Nursing Practice

1. Client Variables

- physiological, sociocultural developmental and spiritual—function to achieve stability in relation to the environmental stressors experienced by the client.

2. Lines of Resistance
- acts when the Normal Line of Defense is invaded by too much stressor causing alteration in the normal health pattern to facilitate coping and overcome the stressors that are present within the individual.

3. Normal Line of Defense
- acts in coordination with the normal wellness state. It is the normal reaction of the client in response to stress – the baseline determinants of wellness within the health continuum.

4. Flexible Line of Defense
- helps the body to adjust to situations that threaten the imbalance within the client's stability.

5. Stressors
Stressors are forces that produce tensions, alterations or potential problems causing instability within the clients system.

6. Reaction
Reactions are the outcomes or produced results of certain stressors and actions of the lines resistance of a client. It can be positive or negative depending on the degree of reaction the client produces to adjust and adapt with the situation.
a. Negentropy is set towards stability or wellness
b. Egentropy is set towards disorganization of the system producing illness

7. Prevention
Prevention is used to attain balance within the continuum of health

Three Levels of Prevention according to this theory:
A. Primary prevention – focuses on foreseeing the result of an act or situation and preventing its unnecessary effects as possible. It also aims to strengthen the capacity of a person to maintain an optimum level of functioning while being interactive with the environment. Ex. health promotion and disease prevention.

B. Secondary prevention – focuses on helping alleviate the actual existing effects of an action that altered the balance of health. It aims to reduce environmental influences that cause an alteration in the stability of the client. Ex. Early diseases detection and prompt treatment.

C. Tertiary prevention – focuses on the actual treatments or adjustments to facilitate strengthening of person after being exposed to stressor. Aims to prevent regression and recurrence of the disease. Ex. Rehabilitation

8. Reconstitution
A state of returning back to old health self.

Application
Practice:
1. Holistic approach in the care of the patients.

Education:
1. Effective in conceptual transition among all levels of nursing education.
2. Basis for continuing education after graduation facilitating professional growth.
3. Validate nursing roles and activities and its applicability beyond nursing practice.

Research:
1. Widely used framework used in nursing research that guides enhancement of nursing care.

Analysis
Simplicity
1. It is simple for people especially health/medical related professionals whom can understand the concepts of health continuum.

Generality
1. Applicable in any health care settings.
2. The theory is comprehensive and adaptable.

Emperical Precision
1. Utilizes empiricism, wherein the theory is testable by mere use of observation.

Clarity
1. Congruent with traditional nursing values.
2. Consistent with other non-nursing theories.

Derivable Consequences
1. Introduction of the nursing process (assessment, nursing diagnosis, planning, implementation and evaluation)
2. Provides guidelines for professional nurses.

References:

Octaviano, E.F. & Balita, C.E. (2008). Theoretical Foundations of Nursing: The Philippine Perspective. Philippines: Ultimate Learning Series, 101-107.

Tomey, A.M. & Alligood, M.R. (2002). Nursing Theorists and Their Work. 5th ed. Missouri: Mosby, 299-316.

Journal Reading

GLOBAL APPLICATIONS OF THE SYSTEMS MODEL

Because the model is flexible and adaptable to a wide range of groups and situations, people have used the model globally, and for more than two decades. Neuman’s first book, The Neuman Systems Model: Application to Nursing Education and Practice, was published in 1982 as a response to requests for data and support in applying the model. Neuman published two additional editions of the book, with the third edition published in 1995 in response to expanded use of the model globally. The third edition includes applications of the Neuman Systems Model to nursing education, practice, administration, and research.

Application of the Neuman Systems Model to Nursing Education

In the 1980s exploration and use of the model greatly accelerated in education at all levels of practice in varied settings. These settings include the United States and locations such as Canada, Europe, Australia, and the Far East. There are many schools of nursing in the United States that have chosen to use the Neuman Systems Model as a curriculum framework or for selected courses. Most schools surveyed indicated reasons they chose the Neuman model. Generally, the reason for choosing the model was consistency with the school in one or more of the following areas: the school’s beliefs; philosophy; and concepts of humans, health, nursing, and environment. Associate degree nursing programs that have used the model include Athens Area Technical Institute, Athens, Georgia; Cecil Community College, North East, Maryland; Central Florida Community College, Ocala, Florida; Los Angeles County Medical Center School of Nursing, Los Angeles Valley College, Van Nuys, California; Santa Fe Community College, Gainesville, Florida; and Yakima Valley Community College, Yakima, Washington.

Baccalaureate nursing programs that have used the model include California State University, Fresno; Indiana University; Indianapolis; Purdue University, Fort Wayne, Indiana; University of Tennessee; and the University of Texas, Tyler. Gustavus Adolphus College, and St. Peter and St. Olaf College, Northfield, Minnesota, also have used the model.

Educational programs in the United States reported benefits with using the model. The model (1) facilitated cultural considerations in the curriculum related to the populations the schools and graduates served, (2) provided a nursing focus as opposed to medical focus, (3) included the concept of clients as holistic beings, (4) allowed flexibility in arrangement of content and conceptualization of program needs, (5) was comprehensive and facilitated seeing the person as composites of the five variables, (6) provided a framework to study individual illness and reaction to stressors, (7) was broad enough to allow educational programs to consider family as the context within which individuals live or as the unit of care, and (8) considered the created environment. Education programs have developed evaluation instruments to determine the effects of using the model as a framework for nursing knowledge.

The primary instrument that is cited in the nursing literature is the Lowry-Jopp Neuman Model Evaluation Instrument. This instrument was developed and used to evaluate the efficacy of using the model at Cecil Community College. The results of a five-year longitudinal study showed that the graduates used the model most of the time when fulfilling roles of care provider and teacher. All classes in the study claimed colleagues rarely knew, accepted, or encouraged model use. Therefore, colleagues in work settings tended to have a negative effect on the use of models. The model is also being used internationally. Craig reported on the experiences of 10 educational institutions in Canada that represent six Canadian provinces. These institutions include the University of Saskatchewan, University of Prince Edward Island, University of Calgary, Brandon University of New Brunswick, Université de Moncton, University of Western Ontario, University of Windsor, Okanagan College, University of Toronto, and University of Ottawa.

Model strengths were reported by educational institutions in Canada. The holistic approach that addressed levels of prevention guided the student to focus on the client in his or her own environment. The model also assisted the student to carry out in-depth assessments, to categorize comprehensive data, and to plan specific interventions with the client. The students did report some difficulty in understanding the complexity of the model, and the developmental and spiritual variables. The students reported that it was not always easy to differentiate between the lines of defense and resistance, or to assess the degree of stressor penetration.

The Neuman Model is also being used in educational institutions in South Australia, the United Kingdom, and Sweden. McCulloch reported that a survey of all Australian university programs showed that four undergraduate programs used the model as the major organizational curriculum framework, and another 16 programs introduced undergraduate and postgraduate students to the Neuman Model as one of several models. Vaughan and Gough found that many nursing and midwifery students chose to use the model in their own practice in the United Kingdom. They also reported that Avon and Gloucestershire College of Health used the model as the guiding principle behind curriculum development for child care. Engberg reported that most colleges throughout Sweden use the Neuman Systems Model as the theoretical framework in the module of primary health in nursing education.

Application of the Neuman Systems Model to Nursing Practice

The Neuman Systems Model is being used in diverse practice settings. In the United States, the model is used to guide practice with clients with cognitive impairment, meeting family needs of clients in critical care; to provide stable support groups for parents with infants in neonatal intensive care units; and to meet the needs of home caregivers, with emphasis on clients with cancer, HIV/AIDS, and head traumas. The model is used in psychiatric nursing, gerontological nursing, perinatal nursing, and occupational health nursing. Internationally, the model is being used in Canada, the United Kingdom, Sweden, the Nether- lands, New Zealand, Australia, Jordan, Israel, Slovenia, and several East Asian countries (e.g., Japan, Korea, and Taiwan). Practice areas include community/ public health care.

Nursing Administration and the Neuman Systems Model

The Neuman Systems Model has been used in diverse nursing administration settings in the United States. These settings include a community nursing center, psychiatric hospital, a continuing care retirement community, and Oklahoma State Public Health Nursing. Poole and Flowers demonstrated how the model is used in case management of pregnant substance abusers. Kelley and Sanders presented an assessment tool that intertwines the management process, the Neuman Systems Model, and environmental dimensions. Walker demonstrated how the model and total quality management are used to prepare health-care administrators for the future.

Nursing Research and the Neuman Systems Model

Gigliotti acknowledged that the Neuman Model’s use as a guide in directing nursing education and clinical practice has received much national and international attention. However, the model’s use as a guide to nursing research and the generation of nursing theory based on the research is in the early stages of development, although growing. In order to facilitate the use of nursing research with the Neuman Systems Model, Meleis has elaborated on principles and approaches that may be used to develop a futuristic agenda to validate the Neuman Systems Theory. Fawcett has offered guidelines for constructing Neuman Systems Model–based studies. Neuman revisited these guidelines in her 1996 article in Nursing Science Quarterly. She acknowledged that the Neuman model has guided a range of study designs, from qualitative descriptions of relevant phenomena to quantitative experiments that tested the effects of prevention interventions on a variety of client-system outcomes. She provided numerous examples of descriptive studies, correlational research, and experimental and quasi-experimental studies. Neuman elaborated on how to construct Neuman Model–based research. Smith and Edgil have proposed a plan for testing middle-range theories with the model. Their plan involved the creation of an Institute for the Study of the Model to formulate and test theories through collaboration, including interdisciplinary as well as multi-site efforts. They suggested directions for the work to be done, an organizing structure, and a task analysis of what and who would be appropriate to participate in task completion. Breckenridge has actually used the Neuman model to develop a middle-range theory based on nephrology practice. Gigliotti has identified conceptual and empirical concerns imposed upon her when she operationalized Neuman’s lines of defense and resistance in her research. She concluded that the Neuman Model offers an excellent and comprehensive framework from which to view the metaconcepts relevant to the discipline of nursing: person, environment, health, and nursing. Gigliotti says it is time to institute the comprehensive research program proposed by Smith and Edgil.

Projections For Use Of The Model In The Twenty-First Century

Neuman believes her model is “both concept and process relevant as a directive toward nursing and other health care activities in the challenging 21st Century”. This model has been used to make projections about the future of nursing and health care. Procter and Cheek and Tomlinson and Anderson provided two examples of this use. Procter and Cheek used the model to project the role of the nurse in world catastrophic events, and Tomlinson and Anderson used the model to project family health as a system. Procter and Cheek studied experiences of Serbian Australians at the time of the civil war in the former Yugoslavia using the Neuman Systems Model to understand the experiences. As a result of the study, the researchers came up with implications for the role of nursing in world catastrophic events. The researchers suggested the goal of nursing in such worldwide events should be to assist individuals and communities to retain maximum wellness and system stability as they strive for a sense of inner peace and contentment against impossible odds.

Tomlinson and Anderson recognized that there is an increasing focus on the family system as a health entity. They acknowledged, however, that there is not a universally accepted definition of “family health” as a systems phenomenon. Tomlinson and Anderson proposed that the nurse who uses the broad concepts of the Neuman Model along with a shared family health systems perspective, in which the whole family is the client in the health promotion enterprise, will be well prepared to meet future nursing challenges.

The Neuman Systems Model has been used for over 2 decades; first as a teaching tool and later as a conceptual model to observe and interpret the phenomena of nursing and health care globally. Dr. Neuman wrote: “The future of the Neuman Systems Model looks bright.” She believes her model can readily accommodate future changes in health care delivery. The reader has been introduced to the model and some of the global applications of the model.

Reference:

Parker, M.E. (2001). Nursing Theories and Nursing Practice. Philadelphia: F.A. Davis Company, 338-341.