BETTY NEUMAN
Betty Neuman
System Model in Nursing Practice
(1924 - 2012)
“Health is a condition in which all parts and subparts
are in harmony with the whole of the client.”
"Betty Neuman" is one of the nursing theorist that excel in the nursing profession with her contributions such as her theory in nursing.
Neuman's system model focuses on our body as a whole system, our body has its own five aspects which helps us to become a whole and complete person. If there is one part that was damaged, the whole of its subparts will be at risk. We must be responsible in taking good care of it. We must always put to our mind the system model because as a nurse, we are very responsible in everyone's health condition.
Life story
- Betty M. Neuman is the originator of the Neuman Systems Model, a comprehensive and influential theory of nursing which has had global impact since its appearance in 1972. Neuman was born in Marietta, Ohio, on September 11, 1924.
- After her graduation from high school in 1942, she moved to Dayton, Ohio, where she worked in the wartime aircraft industry at Wright-Patterson Field. In the fall of 1944 she joined the Cadet Nurse Training Program, training at the Peoples Hospital, Akron, where she received her diploma in 1947.
- Later that year, after a family visit to the West Coast, she settled in the Los Angeles area and went to work as a staff nurse, advancing to head nurse, in the communicable disease department of the Los Angeles General Hospital.
- In 1956 Neuman entered the baccalaureate program at the University of California-Los Angeles School of Nursing, where she earned a B.S.N. (major in Public Health, minor in Psychology) in 1957. From 1964-1966 she did graduate work in UCLA?s program in Mental Health/Public Health Consultation. In the course of her studies she became aware of the development of community mental health centers, then emerging as a new type of clinical setting, and became interested in roles for nurses in these facilities.
- Her master's thesis was a study of the relationship between personality patterns and suicide attempts Upon completion of her M.S. in June 1966, Neuman was appointed chair and faculty member of the UCLA Mental Health/Public Health Consultation program from which she had just graduated. In order to better incorporate nurses into the training of mental/public health workers, she developed a model for teaching community mental health that was successfully tested as a means for utilizing nursing specialists in the mental/public health settings.
Neuman completed a PhD in Clinical Psychology at Pacific Western University, Los Angeles, in 1985. She developed a wide host of professional friends and acquaintances including numerous adherents who adapted the Neuman Systems Model in various areas of nursing health care research, practice, and education. The model was employed by nurses working with many individual, family, and community client groups and in formulating a wide range of diagnosis and treatment plans. Neuman has been honored widely on numerous occasions and holds a number of honorary degrees.
FOUR NURSING PARADIGMS
PERSON
Human being is a total person as a client system and the person is a layered multidimensional being.
Each layer consists of five person variable or subsystems:
Physiological - Refers of the physicochemical structure and function of the body.
Psychological - Refers to mental processes and emotions.
Socio-cultural - 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.
ENVIRONMENT
"the totality of the internal and external forces (intrapersonal, interpersonal and extra-personal stressors) which surround a person and with which they interact at any given time."
The internal environment exists within the client system.
The external environment exists outside the client system.
The created environment is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness.
HEALTH
Health is equated with wellness.
“the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman, 1995)”.
The client system moves toward illness and death when more energy is needed than is available. The client system moved toward wellness when more energy is available than is needed
NURSING
a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor.
person is seen as a whole, and it is the task of nursing to address the whole person.
Neuman defines nursing as “action 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.’’
The role of the nurse is seen in terms of degree of reaction to stressors, and the use of primary, secondary and tertiary interventions.
SYSTEM MODEL THEORY
Betty Neuman describes the person as an open system and she gives importance on rendering care for the patients.She also describe stress as a factor that affects the healyh of the patient.
Her theory is unified and holistic in approach because it can be used in the different health care settins which tends yo help the patuients to recover easily.
MAJOR CONCEPTS
Flexible line of defense
A protective accordion-like mechanism that surrounds and protects the normal line of defense from invasion by stressors.
Normal line of defense
An adaptational level of health developed over time and considered normal for a particular individual client or system; it becomes a standard for wellness-deviance determination.
Lines of resistance
Protection factors activated when stressors have penetrated the normal line of defense, causing a reaction synptomatology. (Neuman, 1995)
SUBCONCEPTS
Stressors
A stressor is any phenomenon that might penetrate both the flexible and normal lines of defense, resulting in either a positive or negative outcome.
Intrapersonal stressors are those that occur within the client system boundary and correlate with the internal environment.
Interpersonal stressors occur outside the client system boundary, are proximal to the system, and have an impact to the system.
Extrapersonal stressors also occur outside the client system boundaries but are at a greater distance from the system than are interpersonal stressors. An example is social policy.
Stability
A state of balance or harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health thus preserving system integrity.
Degree of Reaction
The amount of system instability resulting from stressor invasion of the normal line of defense.
Entropy
A process of energy depletion and disorganization moving the system toward illness or possible death.
Negentropy
A process of energy conservation that increases organization and complexity, moving the system toward stability or a higher degree of wellness.
Input/output
The matter, energy, and information exchanged between client and environment that is entering or leaving the system at any point in time.
Reconstitution
The return and maintenance of system stability, following treatment of stressor reaction, which may result in a higher or lower level of wellness.
Prevention as intervention
Intervention modes for nursing action and determinants for entry of both client and nurse into the health care system.
Primary prevention occurs before the system reacts to a stressor; it includes health promotion and maintenance of wellness. Primary prevention focuses on strengthening the flexible line of defense through preventing stress and reducing risk factors. This intervention occurs when the risk or hazard is identified but before a reaction occurs. Strategies that might be used include immunization, health education, exercise, and lifestyle changes.
Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing symptoms. Secondary prevention focuses on strengthening the internal lines of resistance and, thus, protects the basic structure through appropriate treatment of symptoms. The intent is to regain optimal system stability and to conserve energy in doing so. If secondary prevention is unsuccessful and reconstitution does not occur, the basic structure will be unable to support the system and its interventions, and death will occur.
Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Its purpose is to maintain wellness or protect the client system reconstitution through supporting existing strengths and continuing to preserve energy. Tertiary prevention may begin at any point after system stability has begun to be reestablished (reconstitution has begun). Tertiary prevention tend to lead back to primary prevention. (Neuman, 1995)
ASSUMPTIONS
Each client system is unique, a composite of factors and characteristics within a given range of responses.
Many known, unknown, and universal stressors exist. Each differs in its potential for disturbing a client’s usual stability level or normal line of defense. The particular interrelationships of client variables at any point in time can affect the degree to which a client is protected by the flexible line of defense against possible reaction to stressors.
Each client/client system has evolved a normal range of responses to the environment that is referred to as a normal line of defense. The normal line of defense can be used as a standard from which to measure health deviation.
When the flexible line of defense is no longer capable of protecting the client/client system against an environmental stressor, the stressor breaks through the normal line of defense.
The client, whether in a state of wellness or illness, is a dynamic composite of the interrelationships of the variables. Wellness is on a continuum of available energy to support the system in an optimal state of system stability.
Implicit within each client system are internal resistance factors known as lines of resistance, which function to stabilize and realign the client to the usual wellness state.
Primary prevention relates to general knowledge that is applied in client assessment and intervention, in identification and reduction or mitigation of possible or actual risk factors associated with environmental stressors to prevent possible reaction.
Secondary prevention relates to symptomatology following a reaction to stressors, appropriate ranking of intervention priorities, and treatment to reduce their noxious effects.
Tertiary prevention relates to the adjustive processes taking place as reconstitution begins and maintenance factors move the client back in a circular manner toward primary prevention.
The client as a system is in dynamic, constant energy exchange with the environment. (Neuman, 1995)
RESEARCH #1
Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis
Introduction
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) characterized by brain inflammation, demyelination, and axonal loss, which occurs primarily between the ages of 20–40 years. MS is the most prevalent inflammatory and the second most common cause of neurological disability in working-age adults. Since it usually strikes in the prime of life, frequently progresses to disability, and has no cure, MS can have a strong emotional impact not only on those who suffer from it, but also on the healthcare team. The range of symptoms that occur in MS can have disabling functional consequences for patients and lead to significant reductions in their quality of life and the ability of individuals to carry out their roles and job tasks.
The goal of early disease management is to intervene before irreversible neuronal destruction happens, to delay the progression of disability, and to improve the quality of life. Currently, there is no known cure for MS, and the treatment goal of MS is the prevention of permanent neurological damage. Thus, the nature of the disease poses an obvious need for interdisciplinary services. Nurses have to play a key role in the interaction with patients/clients and their families to improve the patient/client’s health. The purpose of nursing care is to improve the quality of life of patients/clients. An effective way to promote nursing care is by applying nursing theories.
The clinical use of nursing models and theories helps develop nursing knowledge. It is an important step to achieve the goals that guide the practical application of clinical and educational research. A wide variety of situations and phenomena make a certain degree of flexibility necessary in the selection of the models and nursing theories according to the circumstances. The Betty Neuman systems model is one theory that provides guidance at three levels of prevention
Method
This clinical study resulted from the application of the nursing process to a patient/client admitted with multiple sclerosis in the neurological ward of a hospital in an urban area of Iran.
Results
A patient/client was evaluated according to the Neuman model. Intrapersonal stressors (physiological, psychological, socio-cultural, and spiritual), interpersonal stressors (being away from family and children) and extra-personal stressors (aggression and psychological pressure from the spouse) were found. Based on the examination, 12 nursing diagnoses based on the taxonomy of the North American Nursing Diagnosis Association International, and nursing care based on three levels of prevention that are important in the view of Neuman, are presented. The results were used in the classification of nursing interventions and the classification and nursing outcomes respectively.
Conclusions
The results suggest the desirability of care and patient/client satisfaction in the evaluation of nursing care based on the Neuman model. The model can be used as a framework to help nurses care for patients/clients. Thus, the application of this model and other models is recommended in the nursing care of patients/clients.
RESEARCH #2
Application of Betty Neuman Theory in Care of Stroke Patient
Introduction
The brain has a centralized control over the all organ of the body. It has a control on everything whatever we do. Even it is functioning while sleeping. Brain has a very specialized cell and structure, which need sufficient oxygen and nutrient for its own life [1]. The brain cell dies if it not receives oxygen for up to six minutes. Deficiency of oxygen and nutrient to brain cell cause ischemia. This emergency condition needs medical attention and is known as a stroke [2]. A stroke occurs when the supply of blood to the brain is either interrupted or reduced. It can be ischemic and hemorrhage. Stroke is highly prevalent condition leading to chronic disability and death [3]. Multiple factors which lead to increase the risk of stroke are for example unhealthy diet, obesity, hypertension, diabetes mellitus, and tobacco use etc. Symptom of stroke depends upon how much part of brain tissue is involved and which area is affected. Its symptom range from numbness to complete paralysis of body part. This reduces patient quality of life and individual ability to carry out their normal roles and jobs task [4]. For the treatment of stroke health care professionals need to diagnose first type of stroke. The goal of stroke management is to minimize brain damage and preserve brain function. Stroke management involve to delay the progression of disability and to improve the quality of life [5,6]. Nurses have a key role in management of stroke patients. Nurses are the ones who provide care to patients according to need of patients who are not only physical but considering the other aspect as well [7]. The important responsibility on nurses in the management of stroke patient is the interaction with patient and their families to improve patient health [8]. The purpose of nursing care is to improving the quality of life of patients. An effective way to promote nursing care is by applying nursing theories [9]. Nursing theories and model help to develop nursing knowledge in clinical area. In clinical area a wide variety of situation and phenomen as made a certain flexibility of using nursing theories and model in patient care [10]. It’s an effective way to achieve the goal of practical application of clinical in educational research [11]. Betty Neuman theory with the name of Neuman system model is the most effective model which can be applied in these types of patients with long term disease. Neuman system model provide a framework for the nurses to provide a holistic care to the patients. This model discussed the stressor which affects human beings and what the intervention nurses take to help the patients to move toward the recovery. This model emphasis on three level of prevention. (Primary, secondary, and tertiary)
Nursing goal: According to Neuman system model the goal are determining by mutually agreeing between the nurse and patient. Mutual agreement on the goal and intervention are helpful for achieving the patient health. Nurse used three level of prevention as intervention (primary, secondary, tertiary) for relieving patient stressor .The goal and intervention which are applied on this stroke patient are mention in Table 2.
Nursing outcomes: Nursing outcomes shows the evaluation of goal and intervention. Positive response shown by the patient in the variable. Physiological symptom improved except urinary incontinence which needs more intervention to be improved. A patient outcome shows that he was feeling more satisfied and comfortable after performing religious activity. The patient discusses that because of performing religious activity his stress level is much reduces.
Theory concept and relationship: This model shows the relationship of client system with the environment health and nursing. The relationships among these concepts are logical and clearly defined. This model is easily applicable in nursing practice, education and research. Her categorization of client system into the five variable physiological, psychological, developmental, spiritual, sociocultural help the nurses to collect data in multiple perceptive. Her nursing process model is very effective in providing care to patient, three level of prevention as intervention shows that it is applicable in community as well as in hospital setting. Generally this model is well adopted and suited for nursing care application in clinical setting
CONCLUSION The case scenario of Mr X is illustrating the utilization of this model in stroke patient care. This scenario demonstrated that the Neuman system model is very useful for caring of long term disease patient such as stroke. This model help the nurse to understand why patient act in certain way. She assesses all the stressors of that patient and then applied intervention accordingly. Overall the Neuman system model fit very well in current nursing practice. It guides nurses to work with their colleagues as well as with patient, family and communities. It offers a board flexible multidisciplinary framework for the nurses. This model not only direct to the physiological perspective of person but it help to deal the patient in their psychological and spiritual manner as well.
By:
Bognot Cyrene
Cabarrubias Khate
Lardizabal Jessanine
References:
http://dla.library.upenn.edu/dla/pacscl/ead.pdf?id=PACSCL_UPENN_BATES_MC160
http://currentnursing.com/nursing_theory/neuman.html
http://nursingtheories.weebly.com/betty-neuman.html
http://nursingtheories.weebly.com/betty-neuman.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565031/
https://www.jscimedcentral.com/Nursing/nursing-5-1092.pdf
http://lormacollegesnursinginformatics2018.blogspot.com/2018/07/betty-neuman.html