Betty Neuman: The Neuman Systems Model

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Karen S. Reed

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  • Notes on Nursing Theories

    SERIES EDITORS

    Chris Metzger McQuiston

    Doctoral Candidate, Wayne State University

    Adele A. Webb

    College of Nursing, University of Akron

    Notes on Nursing Theories is a series of monographs designed to provide the reader with a concise description of conceptual frameworks and theories in nursing. Each monograph includes a biographical sketch of the theorist, origin of the theory, assumptions, concepts, propositions, examples for application to practice and research, a glossary of terms, and a bibliography of classic works, critiques, and research.

    • Martha Rogers: The Science of Unitary Human Beings

      Louette R. Johnson Lutjens

    • Imogene King: A Conceptual Framework for Nursing

      Christina L. Sieloff Evans

    • Callista Roy: An Adaptation Model

      Louette R. Johnson Lutjens

    • Dorothea Orem: Self-Care Deficit Theory

      Donna L. Hartweg

    • Rosemarie Parse: Theory of Human Becoming

      Sheila Bunting

    • Margaret Newman: Health as Expanding Consciousness

      Joanne Marchione

    • Paterson and Zderad: Humanistic Nursing Theory

      Nancy O'Connor

    • Madeleine Leininger: Cultural Care Diversity and Universality Theory

      Cheryl L. Reynolds and Madeleine M. Leininger

    • Florence Nightingale: An Environmental Adaptation Theory

      Louise C. Selanders

    • Hildegard E. Peplau: Interpersonal Nursing Theory

      Cheryl Forchuk

    • Betty Neuman: The Neuman Systems Model

      Karen S. Reed

    • Ida Jean Orlando: A Nursing Process Theory

      Norma Jean Schmieding

    Copyright

    View Copyright Page

    List of Figures

    Foreword

    Karen Reed's presentation of the Neuman systems model in this easy-to-use, brief format is both timely and pragmatic. Although the intended audience is the undergraduate nursing student, graduate students and faculty alike can avail themselves of this quick and handy resource.

    It has been 20 years since Betty Neuman, Ph.D., published the first and primary article on the Neuman systems model in nursing research. Entitled “A Model for Teaching Total Person Approach to Patient Problems,” the article reveals Dr. Neuman's creativity and purpose for her work. Nursing students needed a unifying focus in which to place their practice. Twenty years later, nursing students more than ever need to develop a client-centered and holistic context for their learning and their practice.

    The Neuman systems model:

    • Provides a worldview of nursing that embraces a systems approach
    • Maintains the centrality of the client to plans of care
    • Clearly establishes nursing as a unique practice that addresses the client system (individual, family, or community) in relationship with the environment

    The Neuman systems model systematically describes what occurs in nursing; provides a holistic approach to care; and, when utilized in practice and research, generates new concepts and theories relevant for nursing. To have been a pioneer in the application of the Neuman model to curriculum development and client approach and to have had the privilege of Dr. Neuman's trust and mentorship is to have received the most precious of gifts. Eagerly, I look forward to future developments in the utilization of the Neuman systems model in education, practice, and research that will be undertaken by those undergraduate students who, having availed themselves of this monograph today, become tomorrow's generation of nurse researchers.

    I would like to acknowledge the work and wisdom of Karen Reed, Ph.D., for providing the undergraduate student with this primer on the Neuman systems model and Betty Neuman, author and theorist, for her relentless energy and commitment to knowledge development as a “letting go” process.

    RosalieMirenda, Professor, Nursing Neumann College, Aston, Pennsylvania

    Acknowledgments

    I am deeply grateful for the support and assistance of Betty Neuman and Rosalie Mirenda during this project. Their encouragement and willingness to help made this assignment the ultimate learning experience.

    I also thank Donna Neff for her help in preparing the manuscript.

  • Glossary

    • Central core

      The basic structure of survival factors “common to the species, such as variables contained within, innate or genetic factors, and strength and weakness of the system parts” (Neuman, 1989, p. 172).

    • Client/client system

      An open system in interaction with the environment, comprised of variables (physiological, psychological, sociocultural, developmental, and spiritual) that form the whole of the client. The client as a system is composed of a core or basic structure of survival factors and surrounding protective concentric rings. The client system may be an individual, group, family, or community (Neuman, 1989).

    • Created environment

      Unconsciously developed by the client as a “symbolic expression of system wholeness.” It is intrapersonal, interpersonal, and extrapersonal in nature. The created environment supersedes and encompasses both internal and external environments (Neuman, 1989, p. 70).

    • Client system stability

      The best possible health state at any given point, where all variables are in balance or harmony with the whole of the client or client system.

      Developmental variable

      Developmental processes of client system.

    • Environment

      All internal and external factors or influences surrounding the identified client or client system. The relationship between the client or client system and the environment is reciprocal. “Input, output and feedback between the client and environment is of a circular nature [such that] the client may influence or be influenced by environmental forces” (Neuman, 1989, p. 70).

    • External environment

      All forces or interaction influences external to or existing outside the defined client or client system.

    • Extrapersonal factor

      Forces occurring outside the client system.

    • Family

      Primary system responsible for the transmission of social values, psychological growth, and spiritual strength of its members who reside within the system. These functions are transmitted through bonds developed by the interrelatedness and communication of individual members (Reed, 1989, p. 385).

    • Flexible line of defense

      A “dynamic state of wellness; system's current, immediate state which is particularly susceptible to situational circumstances; e.g., amount of sleep, hormone level” (Neuman, 1982, p. 137). The flexible line of defense is the boundary between the client system and the environment.

    • Goal of nursing

      To: “facilitate for the client optimal wellness through either retention, attainment or maintenance of client system stability.… To assist the client in creating and shaping reality in a desired direction, related to retention, attainment and/or maintenance of optimal system wellness through purposeful interventions… directed at mitigation or reduction of stress factors and adverse conditions which affect or could affect optimal client functioning, at any given point of time.” (Neuman, 1989, p. 72)

    • Health

      Health “is reflected in the level of wellness. When system needs are met, a state of optimal wellness exists; conversely, unmet needs reduce the wellness state” (Neuman, 1989, p. 71).

    • Internal environment

      All forces or interactive influences internal to or contained solely within the boundaries of the defined client or client system (Neuman, 1989).

    • Interpersonal factor

      A force occurring among two or more client systems.

    • Intrapersonal factor

      A force occurring within the individual.

    • Lines of resistance

      Internal resistant forces that act to decrease the degree of reaction to stressors. They act as resources to help the client return to a stable health condition (personal communication, Neuman, 1992).

    • Normal line of defense

      Adaptational state to stressors over time that is considered “normal” for the individual (Neuman, 1989).

    • Nursing diagnosis

      “Acquisition of an appropriate date base that identifies, assesses, classifies, and evaluates the dynamic interactions among the physiological, psychological, sociocultural, developmental, and spiritual variables comprising the client system. This step of the nursing process takes into account the perceptions of both the client and the caregiver” (Fawcett, 1989, p. 177).

    • Nursing outcomes

      Determined by nursing interventions using one or more of the three prevention modes (Neuman, 1989). Outcomes are the desired results of nursing interventions and are stated behaviorally in terms of the patient. They are derived from the nursing diagnoses and correlate with them. They are classified as short term and long term; they also may be classified as immediate, intermediate, and future. Outcomes will change as the patient/client's status and priorities change. The actual outcomes of the prescribed nursing interventions are evaluated in terms of their relation to the stated outcomes (Neuman, 1989).

    • Neuman Nursing Process

      Designed to implement and facilitate the use of the Neuman systems model for nursing. The nursing process has been systemized into three categories: nursing diagnosis, nursing goals, and nursing outcomes.

    • Physiologic variable

      Bodily structure and function of the client system.

    • Prevention as intervention

      Modes for facilitating integrative processes necessary to retain/attain/maintain stability and integrity of the client or client system. Intervention modes are used within the structure of each of the preventions: primary, secondary, and tertiary (Neuman, 1989).

    • Primary prevention

      Relates to general knowledge that is applied to individual patient assessment in an attempt to identify and allay the possible risk factors associated with environmental stressors. Decreases the possibility of encounter with stressors and strengthens the flexible line of defense in the system to protect the integrity of the normal line of defense.

    • Psychological variable

      Mental processes and relationships of the client system.

    • Reconstitution

      “Represents the return and maintenance of system stability, following treatment of stressor reaction, which may result in a higher or lower level of wellness than previously” (Neuman, 1989, p. 50).

    • Sociocultural variable

      Social and cultural functions of the client system.

    • Spiritual variable

      “Aspects of spirituality. A continuum from complete unawareness or denial to a consciously developed high level of spiritual understanding” (Neuman, 1989).

    • Stressor

      “Any environmental stimulus, problem, or condition capable of causing instability of the system by penetration of the normal line of defense; this may be intra-, inter-, or extrapersonal in nature” (Neuman, 1982, p. 137).

    • Secondary prevention

      Relates to symptomatology, appropriate ranking of intervention priorities, and treatment protocol. Treats system response following stressor penetration of normal line of defense.

    • Tertiary prevention

      Relates to the adaptive process as reconstitution begins, and ultimately moves back in a circular manner toward primary prevention. Assists in repatterning for restoration of the functions that have been altered as a consequence of the response to stressor penetration of the normal line of defense.

    • Variances from wellness

      Determined by comparing the normal health state with what is taking place at a given time period (Neuman, 1989).

    References

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    Beckingham, A. C., & Baumann, A. (1990). The aging family in crisis: Assessment and decision-making models. Journal of Advanced Nursing, 15, 782–787. http://dx.doi.org/10.1111/j.1365-2648.1990.tb01907.x
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    Buchanan, B. F. (1987). Human-environment interaction: A modification of the Neuman systems model for aggregates, families, and the community. Public Health Nursing, 4, 52–64. http://dx.doi.org/10.1111/j.1525-1446.1987.tb00512.x
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    About the Author

    Karen S. Reed is an Associate Professor in the College of Nursing at the University of Akron, Ohio. Her association with Dr. Neuman began in 1979 at Ohio University, where Dr. Neuman first encouraged her to explore the idea of family as a client system. That work was published in the 1982 edition of The Neuman systems model. She has spent the past 12 years continuing to incorporate family constructs within the Neuman model, and was a contributor to the 1989 edition of the Neuman book. In addition, she has presented the family-focused material at several national and international conferences on nursing theory and family nursing. Her most recent work has focused on developing a family assessment model based on the Neuman systems model (NFAM). Her current research interests focus on testing the family assessment model and the impact of perinatal loss on families. Recent publications include an article on miscarriages in Image, an article on the development of NFAM in Nursing Science Quarterly, and two book chapters on family and psychiatric disorders in children in the pediatric textbook Child Health Nursing.

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