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Neuman Systems Model

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Richel Amador

on 16 March 2015

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Transcript of Neuman Systems Model

Betty Neuman
Conclusion


Betty Neuman’s system model provides a comprehensive flexible holistic and system based perspective for nursing.

Neuman's model focuses on the response of the client system to actual or potential environmental stressors and the use of primary, secondary and tertiary nursing prevention intervention for retention, attainment, and maintenance of optimal client system wellness.

Types of stressors

Interpersonal, occurs between individuals

Intrapersonal, occurs within the person

Extrapersonal, occurs outside the individual
Betty Neuman
Neuman Systems Model
Prevention




Primary Prevention
occurs before the system reacts to a stressor (.....) . Job is to protect the normal line (....) and strengthen the flexible line of line of defense to enable him to better deal with the stressors. It involves health promotion and supports wellness.
Secondary Prevention
occurs after the client system reacts to a stressor. Purpose is reducing reaction and strenghtening or removing the central core
Tertiary Prevention
Also occurs after encounter with stressor. The system has been treated through secondary prevention strategies.
offers support to the client and attemps to help the client readapt, and stabilize or return to wellness.



Betty Neuman’s system model provides a comprehensive flexible holistic and system based perspective for 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.



Theoretical Sources
Brief Description
Neuman’s Systems Model first published in 1972.

The Neuman’s system model was designed for UCLA nursing students in hopes to promote their understanding of clients beyond the medical model.

Focuses on the client as an open system composed of five variables that responds to actual or potential stressors in the environment and uses
prevention interventions
to achieve balance between
the systems.




Richel Amador, Sharon Cole, Sindy Herrera, Shannon Morales, Greg Sit
Clinical Significance in our Practice
Stressors
References
1)
http://currentnursing.com/nursing_theory/Neuman.html

Nursing Theories
a companion to nursing theories and models
Dr. Betty Neuman
1924-Present
Born 1924 on farm in Ohio

1947: Completed RN diploma
with double Honours from
People's Hospital in Ohio

1959 received Baccalaureate degree with double Honours in Public health and Psychology,

1966 Master’s degree in Mental Health, Public Health Consultation

1985 Doctoral degree in Clinical Psychology.

1988 Received second Doctoral honour

Worked in different areas in nursing practice ( hospital nurse, school nurse, industrial nurse, communicable disease nurse, clinical instructor)


Why should we appreciate and adopt this model into our practice?
Its emphasis is on wholism, systems, prevention, and client participation for goal setting.

It values clients’ uniqueness within his or her environment, is aimed towards prevention and provides collaboration with other disciplines.

Its focuses on primary prevention and interdisciplinary care as interventions to achieve the maximum possible level of client system stability.

The nurse's role in the care of clients is constantly changing depending on the type of intervention needed.







Relevance of this model for nursing practice today

The client is seen as always being in constant change with its environment, as the individual is affecting and being affected by the environment.



Self Reflection
1. How did stress affect your clinical practice?

2. Reflecting on your community or mental health clinical placements, what level of prevention have you provided to your clients?










(Heyman, 2000)
Definitions
Human Being or Person:

Viewed as an open system that interacts with internal and external environment stressors.
The system constantly changes, moving towards a state of stability or illness

Environment:
Both the internal and external forces that surround a person and that interact with at any given time
Internal: Exists within the client system
External: Exists outside the client system

Health:
Health is equated with wellness.
A person’s state of wellness is in an equilibrium that is always changing due the to person’s constant interaction with the environment.
Neuman viewed health as a wellness-illness continuum and the variables and stressors they encounter influence a person’s position on the continuum.


Major Concepts
(Neuman, 1989)
How Clear is this Theory?
... Stressors

Affect the stability of the system in a positive or negative way.

Intrapersonal stressors: Occur within person.
Interpersonal stressors: Occur between individuals.
Extrapersonal: Occur outside the individual.

To keep stressors and the stress response from negatively affecting the body, the primary nursing intervention is
prevention.
Prevention

Primary
Includes health promotion and maintenance of wellness
Occurs before the system reacts to a stressor
Strengthens the flexible line of defense while manipulating the environment to reduce or weaken stressors.
Secondary
Occurs after the system reacts to a stressor and is provided in terms of existing symptoms.
Focuses on preventing damage to the central core by strengthening the lines of resistance and/or removing the stressor
Tertiary
Occurs after the system has been treated through secondary prevention strategies.
Offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution


Semantic Clarity & Consistency
(Neuman, 1989)
Theory Critique
How Clear is this Theory?
Structural Clarity & Consistency

Freese, B.T. (2005). Betty Neuman’s systems model. In A.M. Tomey & M.R. Alligood (Eds.), Nursing theorists and their work (6th ed., pp. 318-411). St.Louis, MO: Mosby.


Heyman, P. (2002). Neuman’s System’s Model. University of Florida. Retrieved from http://www.patheyman.com/essays/neuman/index.htm

Neuman, B. (1989). Health as a continuum based on the neuman systems model. Nursing Science Quarterly. 129-135




Multiple relationships between concepts are presented in a logical manner

•The structure and interconnectedness of these concepts are made clearer with the help of clear definitions and descriptions as well as the diagram of the model.

•Structure of the theory is easily understood and easy to follow with a bullseye diagram




(Fitzpatrick & Whall, 2005)

(Freese, 2005)



(Freese, 2005)


How Simple is this Theory?
.... For example:

If a client’s system has not reacted to a stressor
(primary prevention)
, then
the nurse would focus interventions on maintaining the healthy state and health promotion
.


However, if system had reacted to the stressor
(secondary prevention)
, then
the nurse would focus on removing the stressor and protecting and preventing damage to the system as well as strengthening the lines of resistance.
In the case that the client was experiencing symptoms
(tertiary prevention)
, clearly the stressors have impacted the system greatly and
nursing interventions would focus on limiting the effects of the stressor on the system, as well as reducing the amount of energy needed to limit the use of energy and preserve the amount available in the system.


Complex theory and it cannot be described as being simple, yet nurses who use the model describe it as easy to understand and it is used across cultures and practice settings (Freese, 2005)

Complex + multidimensional with 9 major concepts:
Wholistic approach
Open System
Environment
Wellness + Illness
Client System
Stressors
Degree of Reaction
Prevention as Intervention
Reconstitution
Relationships exist among concepts:
environmental stressors <----> client system <---> health/ wellness
(Freese, 2005)
nursing prevention modalities <---> <---> reconstitution <---> health/wellness
How General is this Theory?
Multiple phenomena presented in theory:

Wholism of clients
Client response to stressors
Prevention as Nursing Intervention
Entire theory must be understood,
not just isolated concepts
The model is more of a framework and visual representation for thinking about humans and nurses and their interactions.

It was developed to provide nursing students a wholistic overview of the physiological, psychological, sociocultural, and developmental aspects of human beings.

It is universal, which allows it to be adapted to a variety of situations and can be interpreted in many different ways.

How General is this Theory?
The model’s universality allows it to be:
Applied to individuals, groups, families, and communities
Applicable to all areas of nursing – administration, education, and practice.
Applicable to all times









Case Scenario
RN
, BSN, MS, PHD, PHC, FAAN
DR Betty Neuman
Health is seen as the “degree of client wellness that exists at any point in time, ranging from an optimal wellness condition, with available energy at its maximum, to death, which represents total energy depletion”. Thus, according to Neuman, the levels of energy within the clients system will determine whether one is ‘well’.
Neuman describes nursing as a “unique profession” that focuses on the person as a whole, and the variables that affect the response to stressors. According to Neuman, retaining and attaining stability in the client system to reduce stressors is the most important goal of nursing.
The Neuman Nursing process format...

1. nursing diagnosis
– nurse obtains a broad, complete database from which inconsistencies from wellness can be determined.

2. nursing goals
– goals are then established by negotiation with the client for preferred changes to correct variances from wellness.

3. nursing outcomes
- determined by nursing intervention through the use of one or more the three prevention as intervention modes.
Evaluation
takes place to confirm the desired outcome goals or to reformulate the goals.
Includes three steps:
The model consists of various tools designed to facilitate the use of the model in nursing practice.These instruments include:
The extensiveness and wholistic approach of the model has proved applicable in a variety of nursing practice settings with individuals, families, groups, and communities.
It allows for interdisciplinary collaboration through the recognition of a client system and classification of stressors that can be understood and utilized by all team members.
Use of this model by nurses facilitates goal-oriented, united and wholistic approach to client care.
An assessment and intervention tool to assist nurses collect and synthesize client data,
A plan for prevention as intervention
And a plan for application of the nursing process within the Neuman systems model.
(Fitzpatrick & Whall, 2005)
(Freese, 2005)
(Freese, 2005)
... Case Scenario Continued
Due to his changes in mannerisms, the company decided to temporarily relieve him from his position at the firm. A week later he experienced episodes of mania and depression. His family became worried, and called an ambulance after he locked himself in the room, refusing to eat, and most of the time quiet and staring blankly on the wall. Later he developed pneumonia.
Mr. Smith is a 51 year old accountant. His colleagues describe him as hardworking, perfectionist and workaholic. His day starts by leaving the house very early from Burnaby to downtown Vancouver and begins work by delegating various tasks with firm expectations and deadlines that are somewhat impossible to meet. If work is not done, he usually responds with pressure and intimidation. He smokes and drinks alcohol whenever he is stressed. Recently the company where he works experienced a decrease in clientele and his boss is putting blame on him. Mr. Smith began exhibiting strange mannerisms and behaviours that were noticed by his family and close friends. He misses meals very often and sleeps very late at night while doing work. He has no time for his family anymore and focuses too hard on meeting deadlines for his work.
Discussion Activity
In Your Groups:
1. Using Betty Newman's Systems Model, identify some of the possible stressors that contributed to Mr. Smith's current health status.

2. What are some primary prevention strstegies that would have helped Mr. Smith before he reacted to the stressors? Also, what are some secondary and tertiary prevention interventions to keep the stressors from continuing to harm Mr. Smith?

Definitions, descriptions and concepts are straightforward and consistent throughout the theory
Clear and consistent concepts and definitions facilitate understanding of the diagram which can initially seem overwhelming and complex
... The model's universality allows it to be :

Applied to individuals, groups, families, and communities

Applicable to all areas of nursing, including administration, education, and practice.

Applicable to
all times
How Accessible is the Model?
Selected and utilized in a variety of nursing practice settings with individuals, families, groups, and communities.

Has been applied and adapted to various specialties, including family therapy, public health, rehabilitation, and hospital nursing.
Used effectively in advanced nursing practice such as psychiatric home visits, critical care, collaborative practice by nurse practitioners and physicians.
Also, the model is being studied and applied in other disciplines, such as physical therapy.
The Model's Concepts
The concepts are abstract but familiar to nurses.
Concepts are comprehensible and adaptable in a variety of practice settings.
Some of them are complex yet logical, and some of them overlap.
Furthermore...
EDUCATION
Used widely as a curriculum guide oriented toward wellness
Guides clinical learning and health promotion
RESEARCH
One of most frequently used models for research.
Has provided conceptual framework for published research on nurses as caregivers and on nursing education and administration.
They are relevant to practice as they facilitate the nursing process by guiding clients' assessment and interventions.
Flexible Lines of Defense

Outer barrier or cushion to the normal line of defense, line of resistance, and the core.

Protects the normal line of defense from invasion by stressors.

Constantly changing and can be altered in a relatively short period of time.
Normal Line of Defense

It is dynamic, represents what the client has become over time, or the usual state of wellness.

Can change over time in response to coping or responding to the environment.

Perceived as a Protective buffer for preventing stressors from breaking through usual wellness state
E.g. Sleep or Rest

Lines of Resistance

Protect the core and activate when environmental stressors invade the normal line of defense.

Represent resource factors that help the client defend against stressors.
E.g. Body's immune response system
Reconstitution
Is the state of adaptation to stressors in the internal and external environment

Return and maintenance of system stability, following treatment for stressor reaction, which may result in a higher or lower level of wellness.



Describes homeostasis as the process by which an organism maintains equilibrium, and consequently its health.
Gestalt Theory
Suggests properties of parts are determined partly by the larger wholes within a dynamically organized systems.
Marx
de Chardin
Philosophy of the wholeness of life.
Selye's stress theory
Any tension producing stimuli that causes a response (positive or negative).
Caplan
Adapted levels of prevention (primary, secondary, tertiary).
Elements exist within some concepts (ie. client system)
The concepts of client, environment, health and nursing match that of traditional nursing values
E.g. Emotions
E.g. Role Expectations
E.g. Job Pressure

Made up of the basic survival factors common to the species:
system variables, genetic features, strengths and weaknesses of the system parts.
Stability, or homeostasis, occurs when there is more energy available than energy being used by the system.
A stable body system is constantly in a changing process of input, output, feedback, and compensation, which results in a state of balance.


Central Core
energy resources
Lines of Resistance protect the Core
Normal Life of Defense
Flexible Line of Defense
The Client System
Major Concept
Major Concept
Person Variables

Each layer, or circle, is made up of five person variables:

Central Core
Accessibility:
Stress managing
Re-assessing patient's ability to independently perform and maintain variables of health.
Regular consult to psychiatrist.
Maintaining client's support system.
Medication (to treat symptoms)
Opportunities to vebalize feelings and concerns.
Stress management activities
Relaxation techniques
Anger-management techniques
Smoking cessation
Summary
A theory with a holistic approach with focus on the client and the environment
It values clients’ uniqueness within his or her environment, is aimed towards prevention
Aides the client in returning to their baseline health through primary, secondary, or tertiary prevention
Practical in the role of nursing today by guiding nurses in identifying stressors and developing nursing interventions
References
Freese, B.T. (2005). Betty Neuman’s systems model. In A.M. Tomey & M.R. Alligood (Eds.),
Nursing theorists and their
work
(6th ed., pp. 318-411). St.Louis, MO: Mosby.

Heyman, P., & Wolfe, S. (2000). Neuman systems model. Retrieved from http://patheyman.com/essays/neuman/
index.htm
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