Neuman

1
Neumans Systems Model

• Presented By
• Prof. Dr. Nefissa A. Kader
• Vice Dean of Education and Student Affairs
• Professor of Psychiatric Mental Health Nursing

2
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.

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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.

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History of model developmentContd.

• 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).
        

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Betty Neuman Biographical Information
1924 1947 Born near Lowell, Ohio. Received RN Diploma from Peoples Hospital School of Nursing, Akron, Ohio. Moved to California and gained experience as a hospital staff, and head nurse school nurse and industrial nurse and as a clinical instructor in medical-surgical, critical care and communicable disease nursing.
1957 Attended University of California at Los Angeles (UCLA) with double major in psychology and public health. Received BS in nursing from UCLA. Received Masters degree in Mental Health, Public Health Consultation from UCLA.
1966 Recognized as pioneer in the field of nursing involvement in community mental health. Began developing her model while lecturing in community mental health at UCLA.
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Betty Neuman Biographical Information contd.
1972 Her model was first published as a model for teaching total person approach to patient problems in nursing research.
1985 Received doctorate degree in clinical pathology from Pacific Western University.
1998 Received second honorary doctorate from Grand Valley State University.
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Influences

• Neumans 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

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Influences contd.

• 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.

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Influences contd.

• 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.

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Influences contd.

• 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).

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Influences contd.

• 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.

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Influences contd.

• 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.

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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

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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 clients
  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 clients
  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.

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Underlying Assumptions contd.

• 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

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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.

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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).
• Neumans holistic, multidimensional approach
  (1990) also reflects the reciprocal interaction
  world view.

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World View contd.

• Resistance and change are linked in Neumans
  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 Selyes mechanistic theory of stress and
  adaptation.
• The mechanistic view is evident in NSM by using
  Selyes theory of stress (Stimuli- response).

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Unique focus of the Model

• The unique focus of the Neumans 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.

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Unique focus of the Model contd.

• 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.

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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.

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Key Concepts contd.

• 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.

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Key Concepts contd.

• ENVIRONMENT
• Internal and external forces affecting and being
  affected by the client at any time within
  environment.
• CREATED ENVIRONMENT
• It is the clients unconscious mobilization of
  all system variables toward system stability,
  Integration, and integrity.

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Key Concepts contd.

• 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.

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Key Concepts contd.

• 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.

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Key Concepts contd.

• 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.

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Key Concepts contd.

• A stressor it is any environmental force which
  can potentially affect the stability of the
  system they may be
• Intrapersonal - occurs within person, e.g.
  emotions and feelings
• Interpersonal - occurs between individuals
  system boundary and one or more other system e.g.
  role expectations
• Extrapersonal - occurs outside the individual,
  e.g. job or finance pressures

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Key Concepts contd.

• 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.

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Key Concepts contd.

• 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

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Key Concepts contd.

• 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.

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Key Concepts contd.

• PREVENTION is 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
  reacts to 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.

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Key Concepts contd.

• 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.

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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.

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Nursing contd.

• 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
  clients encounter with certain stressors or to
  implement an appropriate intervention within the
  three levels of prevention (1989)

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Nursing contd.

• At the primary prevention level 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.

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Nursing contd.

• 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.

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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.

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NURSING METAPARADIGM

• 2-Person
• Neumans 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.

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Person contd.

• The client possesses various lines of defense 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
  clients usual stability state.
• Ones normal life of defense represents the
  clients ability to adjust to daily environmental
  stressors.
• Protecting the normal line of defense and serving
  as the outer boundary of the clients system is
  the flexible line of defense.

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Person contd.

• 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

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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
  

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Environment contd.

• The created environment is unconsciously
  developed by 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).

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Environment contd.

• 3-Environment contd.
• Stressors occur within internal and external
  environment and are classified as being intra,
  inter, or extrapersonal in nature.
• Intrapersonal stressoroccurs 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.

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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 clients 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)".

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NURSING METAPARADIGM

• 4-Health contd.
• 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.

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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.

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Propositions

• Each individual has a normal line of defense
  which is that persons 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).

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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.

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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.

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Thank You