Transcript nu500_neuman_presentationfinal2(2)

Neuman Systems Model
Roline Campbell
Roxy Johanning
Tracy Hill
Presentation Objectives:
1.
Introduce Betty Neuman
2.
Overview of the Neuman Systems Model (NSM) it’s
concepts and principles
3.
Evaluate the NSM nursing theory using Fawcett’s criteria
4.
Compare the NSM with two other nursing theories
5.
Discuss and analyze the use of the NSM
Meet Betty Neuman
•Born in 1924 on a farm near Lowell, Ohio.
• Completed initial nursing education
• Then moved to Los Angeles
• Worked in a variety of nursing roles - always
with an interest in human behavior.
• She attended UCLA
• 1957: Completed bachelor’s degree with a
double major in Public Health & Psychology.
• Helped her husband to establish and
manage his medical practice.
Career advances
1966: Master’s degree in Mental Health, Public Health
Consultation from UCLA.
• Pioneer of nursing involvement in mental health.
• Late 1960’s: Teaching and practice model for mental health
consultation.
• Requests from UCLA graduate students prompted the
design of a conceptual model for nursing in 1970.
• First published in 1972 in an article entitled “A Model for
Teaching Total Person Approach to Patient Problems”
(Neuman & Young, 1972).
• 1974 – 2002: Further development and refinement of the
NSM. (First called “The Neuman Systems Model” in 1985 –
retained the same title since then.)
• 1985: Doctoral degree in Clinical Psychology from PWU.
•
Recent years
Maintained involvement in variety of professional
and international activities
• Moved back to Watertown, Ohio and practiced as a
licensed clinical marriage and family therapist.
• Founder/Director of the Neuman Systems Model
Trustees Group, Inc.
• Holds two Honorary Doctorates
•
•1992: Honorary Doctorate of Letters (Neuman College)
•1998: Honorary Doctorate of Science (Grand Valley State
University)
•Fellow
of the American Academy of Nursing (1993)
Betty Neuman as keynote speaker at the
University of Maine, Fort Kent in 2004.
“It is important to
state that neither was
I knowledgeable
about nursing models
nor had a clear trend
yet begun in nursing
for developing
models.The Neuman
Systems Model was
developed strictly as a
teaching aid”
- Betty Neuman, 2002
An Overview of the
Neuman Systems Model
Philosophical Claims
o Wholism
o Wellness orientation
o Client perception and motivation
o Dynamic systems perspective of energy &
variable interaction with the environment
o Client & caregiver in partnership
Key Concepts
Classified according to the applicable metaparadigm
forerunner.
Human
Beings
• Client/Client
System
• Interacting
Variables
• Basic Structure
• Flexible line of
Defense
• Normal line of
Defense
• Lines of
Resistance
Environment
• Internal
Environment
• External
Environment
• Created
Environment
• Stressors
Health
• Health/Wellness/
Optimal Client
System Stability
• Variances from
Wellness
• Illness
• Reconstitution
Nursing
• Prevention as
Intervention
Client/Client System
Viewed as open system
o Repeated cycles of input, process, output &
feedback
o Thus a dynamic organizational pattern
o Can be
o
•
•
•
•
•
Individual
Family
Group
Community
Aggregate (Social Issue)
Interacting Variables
Developmental
Spiritual
Socio-cultural
Psychological
Physiological
Present in
each type of client
Consider these
simultaneously &
comprehensively
Central Core
Basic survival
factors
Normal temp range
Genetic Structure
Response pattern
Organ strength/weakness
Ego structure
Flexible Line of Defense (FLD)
• Outer barrier
(protective buffer)
• Dynamic – can be
altered in relatively short
period of time
•Prevents stressor invasion
of the client system
Normal Line of Defense (NLD)
Client’s normal wellness
level

What client has become /
evolved into over time

Defines the stability &
integrity of client system
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
Standard from which to
measure health deviation
Lines of Resistance
• Protective mechanism
•Attempts to stabilize the client
system (support return to wellness)
• Supports the basic structure &
normal line of defense
• Contains resource factors
Internal Environment
Forces & interactive
influences confined
within client system
Intrapersonal
Stressors
External Environment
Forces & interaction influences
existing outside the client
system
Created Environment
Symbolic
expression of
system wholeness
Unconscious mobilization
of all system variables
Interpersonal
Wellness and Illness
Optimal Wellness
• System stability
• Greatest possible
degree of system
stability at a given
point in time
Illness
• State of insufficiency
• Disrupting needs are
unsatisfied
• Excessive expenditure
of energy
Variance from Wellness
• Varying degrees of system instability
• Difference from the normal or usual wellness
condition.
Prevention as Intervention
Basis for health promotion
o Nursing is prevention as intervention
o Three dimensions
• Primary prevention
• Secondary prevention
• Tertiary prevention
o
Primary Prevention
o
Health promotion & Maintenance of wellness
o
Occurs before the system reacts to a stressor
o
Strengthens the client / client system to better
deal with stressors (FLD)
o
May also try to manipulate the environment to
reduce or weaken stressors
Secondary Prevention
o
Focus on preventing damage to the Central Core
o
Occurs after the system reacts to a stressor
o Aims
o
to strengthen the Lines of Resistance
May also try to remove the stressor
Tertiary Prevention
o
Occurs after the client/client system has been
treated through secondary prevention strategies
o
Offers support to the client
o Attempts
to:
• add energy to the system or
• reduce energy needed in order to facilitate
reconstitution
Reconstitution
The determined energy increase related to
the degree of reaction to a stressor
 Represents the return and maintenance of
system stability following treatment
 May be viewed as feedback from the
input/output of secondary prevention
 Complete reconstitution may occur

◦ Level beyond the initial Normal Line of Defense
◦ Same level of wellness prior to illness
◦ Lower level where system stability is re-defined
Evaluation
of the
Neuman
Systems
Model
Jacqueline Fawcett and Betty Neuman at
the 8th Neuman Systems Model Symposium
- Salt Lake City, 2001
Jacqueline Fawcett on Betty
Neuman’s System Model Theory:
Neuman System Model Trustee since:
1988
 Areas of Consultation with the Neuman
Systems Model:

◦ Serve as a mentor and consultant for
students, post-doctoral fellows, faculty, and
clinicians interested in using nursing models
and theories to guide their research and
practice, including the Neuman Systems
Model.
Selected Neuman Systems
Model Publications
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Fawcett, J., Carpenito, L. J., Efinger, J., Goldblum-Graff, D., Groesbeck, M. J., Lowry, L. W.,
McCreary, C. S., & Wolf, Z. R. (1982). A framework for analysis and evaluation of conceptual
models of nursing with an analysis and evaluation of the Neuman Systems Model. In B.
Neuman (Ed.), The Neuman Systems Model. Application to nursing education and practice
(pp. 30-43). New York: Appleton-Century-Crofts.
Fawcett, J. (1989). Analysis and evaluation of Neuman's systems model. In B. Neuman (Ed.),
The Neuman Systems Model. Application to nursing education and practice (2nd ed., pp. 6592). Norwalk, CT: Appleton and Lange.
Fawcett, J. (1995). Constructing conceptual-theoretical-empirical structures for research:
Future implications for use of the Neuman systems model. In B. Neuman, The Neuman
Systems Model (3rd ed., pp. 459-471). Norwalk, CT: Appleton and Lange.
Beynon, C.E., Chadwick, P.L., Chang, N.J., Craig, D.M., Fawcett, J., Freese, B.T., Hinton-Walker, P.,
& Neuman, B. (1997). The Neuman systems model: Reflections and projections. Nursing
Science Quarterly, 10, 18-21.
Fawcett, J. (2001). The nurse theorists: 21st century updates—Betty Neuman. Nursing
Science Quarterly, 14, 211-214.
Fawcett, J., & Giangrande, S.K. (2001). Neuman Systems Model-based research: An integrative
review project. Nursing Science Quarterly, 14, 231-238.
Fawcett, J., & Gigliotti, E. (2001). Using conceptual models of nursing to guide nursing
research: The case of the Neuman Systems Model. Nursing Science Quarterly, 14, 339-345.
Selected Neuman Systems
Model Publications (cont.)
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Neuman, B., Aylward, P.D., Beynon, C., Breckenridge, D.M., Fawcett, J., Fields, A., Lowry, L.,
Memmott, R.J., & Toot, J. (2001). The Neuman systems model: A futuristic care perspective. In
N. L. Chaska (Ed.), The nursing profession: Tomorrow and beyond (pp. 321-330). Thousand
Oaks, CA: Sage.
Neuman, B., & Fawcett, J. (Eds.). (2002). The Neuman systems model (4th ed.). Upper Saddle
River, NJ: Prentice Hall.
Freese, B.T., Neuman, B., & Fawcett, J. (2002). Guidelines for Neuman systems model-based
clinical practice. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed., pp.
37-42). Upper Saddle River, NJ: Prentice Hall.
Louis, M., Neuman, B., & Fawcett, J. (2002). Guidelines for Neuman systems model-based
nursing research. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed., pp.
113-119). Upper Saddle River, NJ: Prentice Hall.
Fawcett, J., & Giangrande, S.K. (2002). The Neuman systems model and research: An
integrative review. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed., pp.
120-149). Upper Saddle River, NJ: Prentice Hall.
Gigliotti, E., & Fawcett, J. (2002). The Neuman systems model and research instruments. In B.
Neuman & J. Fawcett (Eds.). The Neuman systems model (4th ed., pp. 150-175). Upper
Saddle River, NJ: Prentice Hall.
Newman, D.M.L., Neuman, B., & Fawcett, J. (2002). Guidelines for Neuman systems modelbased education for the health professions. In B. Neuman & J. Fawcett (Eds.), The Neuman
systems model (4th ed., pp. 193-215). Upper Saddle River, NJ: Prentice Hall.
Shambaugh, B.F., Neuman, B., & Fawcett, J. (2002). Guidelines for Neuman systems modelbased administration of health care services. In B. Neuman & J. Fawcett (Eds.), The Neuman
systems model (4th ed., pp. 265-270). Upper Saddle River, NJ: Prentice Hall.
Fawcett’s Criteria to Evaluate
Nursing Theory
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Significance
Internal Consistency
Parsimony
Testability
Empirical Adequacy
Pragmatic Adequacy
Significance - Meets
Metaparadigm concepts & propositions are
explicitly stated
 All philosophical claims are addressed
 Support of colleagues and the influence of
other scholars & adjunctive disciplines are
acknowledged (Psychology & Philosophy)
 Special contributions made by NSM to
discipline of nursing are identified

◦ Usefulness in Education, Research, Practice &
Administration of Health Care Services
Internal Consistency - Meets
Neuman values a holistic (“wholistic”),
systems-based approach to the care of
clients.
 Revisions and refinements indicates
Neuman’s responsiveness to critiques.
 The basic intent, meaning, and purpose of
the model have been retained.

Parsimony - Meets

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
NSM is sufficiently comprehensive with regard
to depth of content.
The revisions and refinements in Neuman’s
(2002d) current version have clarified several
areas of confusion found in earlier versions and
have improved the adequacy of concept
definitions and descriptions (Fawcett, 2005).
Confusion still remains in the Family,
Community, and Social Issue dimensions of the
Client/Client System – these dimensions require
definitions or descriptions that go beyond being
described as kinds of groups.
Testability - Meets
The guidelines for research based on NSM
are clearly defined and are congruent with
the theory (Optimal Client System
Stability).
 Research and practice are linked: Problems
encountered in practice give rise to new
research questions (Fawcett, 2005).
 NSM based research continues to increase.

Empirical Adequacy –
Partially met
The content of the NSM is not
completely logically congruent.
 Additional research is clearly warranted
(Varying statistical significance).
 Neuman considers her model to be
appropriate for use by members of all
health-care disciplines.

Pragmatic Adequacy - Meets
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Extensive study of the concepts of the NSM and
relevant theories from nursing and adjunctive
disciplines is required before knowledgeable
application in nursing research, education,
administration, and practice.
The content of the NSM comprises many terms,
but most are familiar words; therefore, use of the
model does not require mastery of an extensive
vocabulary.
The success of the NSM as a guide for nursing
curricula and for delivery of nursing services is
documented in several reports (Fawcett, 2005).
Comparison of NSM with
two other nursing theories /
models
Comparison
Rogers
(1970)
Science of
Unitary
Human
Beings
Neuman
Roy
(1970)
(1970)
Neuman’s
Roy’s
System
Adaptation
Model
Model
Contemporaries of one another
Martha
Rogers
Betty
Neuman
Sister
Callista
Roy
Each Define the Metaparadigm
Concepts:
Person
 Environment
 Health
 Nursing

Each Used in Nursing:
Practice
 Administration
 Education

• Two Grand
Theories
and Three
Middlerange
theories
based on
NSM
(Fawcett,
2005, p.
184)
Sister Callista Roy
• Six Grand
theories
and 12
Middlerange
theories
based on
SUHB
(Fawcett,
2005, p.
332-333)
Betty Neuman
Martha Rogers
Theories derived from:
• One Grand
theory and
Nine
Middlerange
theories
based on
RAM
(Fawcett ,
2005, p.
389, 39293)
Goal of Nursing
To Promote Human Betterment wherever People Are, on
Planet Earth or in Outer Space. (Fawcett, 2005, p. 316)
To Facilitate Optimal Wellness for the Client Through
Retention, Attainment, or Maintenance of Client System
Stability. (Fawcett, 2005, p. 167)
To Promote Adaptation for Individuals and Groups in the
Four Adaptive Modes, Thus Contributing to Health, Quality
of Life, and Dying with Dignity by Assessing Behavior and
Factors That Influence Adaptive Abilities and by Intervening
to Expand those Abilities and to Enhance Environmental
Interactions (Fawcett,2005, p. 365)
Overview
Focus is on unitary, irreducible
human beings & their environments.
(Fawcett, 2005, p. 315)
Focus is on wellness of client
system in relation to environmental
stressors and reactions to the
stressors. (Fawcett, 2005, p. 166)
Focus is on human adaptive system
responses and environmental
stimuli, which are constantly
changing. (Fawcett, 2005, p. 365)
Worldview
Reflects the simultaneous
action worldview
Reflects the reciprocal
interaction worldview
Reflects the reciprocal
interaction worldview
Reciprocal Interaction Worldview
This worldview is a synthesis of elements from the
organismic, simultaneity, totality, change, persistence
and interactive-integrative world views:
 Human beings are holistic; parts are viewed on the
context of the whole
 Human beings are active, and interactions between
human beings and their environments are reciprocal
 Change is a function of multiple antecedent factors,
and may be continuous or may be only for survival
 Reality is multidimensional, context dependent, and
relative
(Fawcett, 2005, p.12-13)
Simultaneous Action World View
This world view combines elements of the
organismic, simultaneity, change and unitarytransformative world views:
 Unitary human beings are identified by pattern
 Human beings are in mutual rhythmical
interchange with their environments
 Human beings change continuously, unpredictably
and in the direction of more complex selforganization
 The phenomena of interest are personal
knowledge and pattern recognition
(Fawcett, 2005, p. 13)
Meets Fawcett’s Criteria for
Evaluation of Nursing Models
Rogers
 Roy
 Neuman

(Fawcett 2005, p. 57-58)
Selection Rationale
Roy
Rogers
Neuman
Discussion of the Nurse as the
Client
Galloway (1993) offered an informative NSM-based selfanalysis of her practice with a mentally and physically
impaired infant. She stated:
 “Through analyzing my role as a student nurse in a difficult
clinical situation, I learned that I not only adapted well but also
experienced personal growth. I did not avoid the reality of my
situation; rather, I worked within the difficulties it presented.
Understanding the importance of identifying and expressing
emotions, I did not deny my positive and negative feelings. By
using effective coping mechanisms and introducing alternative
methods as necessary to deal with stressors, I achieved a
positive result. Although my flexible line of defense contracted
slightly due to the influence of specific negative variables, it
buffered effectively so that my underlying normal line of
defense was not penetrated (p. 36).” (Fawcett, 2005, p. 206)

Discussion Points
Steps taken to ensure the
Continued Evolution of the NSM

Establishment of the NSM Trustees Group
◦ Support & promote the NSM through scholarly
work & professional forums

Establisment of the NSM Archives at
Neumann College in Aston, Pennsylvania
◦ Facilitates access to important documents

Establishment of the Neuman Institute
◦ Enhance continuation of NSM-based scholarly
work