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Neuman Systems Model Cornelia Campbell (Roline) Tracy Hill Roxy Johanning 1. 2. 3. 4. 5. Introduce Betty Neuman Overview of the Neuman Systems Model (NSM), concepts and principles Evaluate the NSM nursing theory using Fawcett’s criteria Contrast the NSM with two other nursing theories Discuss and analyze the use of the NSM Betty Neuman (1924•Born in 1924 on a farm near Lowell, Ohio. • After completion of her initial nursing education, she moved to Los Angeles to live with relatives. •Worked in a variety of nursing roles - always with an interest in human behavior. •She attended UCLA; graduated 1957 with a double major in Public Health and Psychology. •Helped her husband to establish and manage his medical practice. •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. Career advances (con’t) 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. • • Maintained involvement in variety of professional and international activities • Numerous publications • Paper presentations • Consultations • Lectures • Conferences. • Moved back to Ohio and practiced as a licensed clinical marriage and family therapist. • Maintains leadership role in the Neuman Systems Model Trustees Group “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 as keynote speaker at the University of Maine, Fort Kent, 2004. - Betty Neuman, 2002 An overview of the Neuman Systems Model “ The philosophic base of the Neuman Systems Model encompasses wholism, a wellness orientation, client perception and motivation, and a dynamic systems perspective of energy and variable interaction with the environment to mitigate possible harm from internal and external stressors, while caregivers and clients form a partnership relationship to negotiate desired outcome goals for optimal health retention, restoration and maintenance. This philosophic base pervades all aspects of the model.” Neuman, 2002 o Wholism o Wellness orientation o Client perception and motivation o Dynamic systems perspective of energy and variable interaction with the environment o Client & caregiver in partnership 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 Concept: Client / client system Viewed as open system Repeated cycles of input, process, output & feedback Thus a dynamic organizational pattern Can be Individual Family Group Community Aggregate Concept: Interacting Variables Physiological Developmental Present in each type of client Psychological Consider these simultaneously and comprehensively Spiritual Socio-cultural Concept: Central Core System variables Weaknesses Basic survival factors Genetic features Strengths Concept: Central Core System variables Weaknesses Basic survival factors Genetic features Strengths Outer barrier Accordion-like Dynamic – can be altered in relatively short period of time Normal line of Defense Lines of Resistance Neuman’s Context Conceptual System Conceptual Diagram Small group exercise / application discussion Other theories based on NSM 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: 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. 65-92). 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, 231238. 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. 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 model-based 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 model-based 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 Significance Internal Consistency Parsimony Testability Empirical Adequacy Pragmatic Adequacy Significance - Meets All of Neuman’s philosophical claims are addressed: Human beings - client as an open system. Environment - contains both internal and external stressors (neutral) and resistance factors (determined by client to be + or -). ○ client => energy exchange <= environment Health – represents a usual dynamic stability state of the normal line of defense; stressors penetrate normal line of defense, causing illness. Nursing - goal is optimal client system stability or wellness; perceptual distortions are mutually negotiated and resolved. Prevention as intervention. Neuman acknowledged the support of colleagues and the influence of other scholars on the development of the NSM, as well as adjunctive disciplines. UCLA Internal Consistency - Meets Neuman values a holistic (“wholistic”), systems-based approach to the care of clients. The basic intent, meaning, and purpose of the model have been retained. Parsimony - Meets Is the theory content clearly stated? 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 Is there research methodology developed? Is it congruent with the theory? 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 – Meets in part? Are study findings congruent with the concepts and principles? Are theoretical assertions congruent with empirical evidence? The content of the NSM is not completely logically congruent. Neuman considers her model to be appropriate for use by members of all health-care disciplines. Pragmatic Adequacy - Meets Special training required? Has it been used in “real world” practice? Effectiveness measurable? Comparisons in situations with and without theory use? 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). Critical Analysis of NSM - Fawcett Comparison Rogers Neuman Roy (1970) (1970) (1970) Science of Neuman’s Roy’s Unitary System Adaptation Human Model Model Beings Contemporaries of one another Martha Rogers Betty Neuman Sister Callista Roy Each Defines: Person Health Environment Nursing Used in nursing: Practice Administration Education Meets Fawcett’s criteria eligibility: Rogers Roy? Neuman? Sister Callista Roy • Grand theories and midrange theories based on SUHB Betty Neuman Martha Rogers Theories derived from: Goal of Nursing Promote human betterment wherever people are, on the planet or in outer space. To facilitate optimal wellness for the client through retention, attainment, or maintenance of client system stability. Overview Focus is on unitary, irreducible human beings and their environments. Focus is on wellness of client system in relation to environmental stressors and reactions to the stressors. Focus is on human adaptive system responses and environmental stimuli, which are constantly changing. Worldview Rogers Roy Neuman To Conclude