Neuman’s Nursing Theory – Presentation Transcript
1. Nursing Theory : Betty Neuman’s By: Harpreet Kaur M.Sc. 1st year
2. Biographical Information 1924 Born near Lowell, Ohio. 1947 Received RN Diploma from Peoples Hospital School of Nursing, Akron, Ohio Moved to California and gained experience as a hospital, staff, and head nurse; school nurse and industrial nurse; and as a clinical instructor in medical-surgical, critical care and communicable disease nursing. 1957 Attended University of California at Los Angeles (UCLA) with double major in psychology and public health. Received BS in nursing from UCLA.
3. 1966 Received Masters Degree in Mental Health, Public Health Consultation from UCLA. Recognized as pioneer in the field of nursing involvement in community mental health. Began developing her model while lecturing in community mental health at UCLA. 1972 Her model was first published as a ‘Model for teaching total person approach to patient problems’ in Nursing Research. 1985 Received doctorate in Clinical Psychology from Pacific Western University. 1998 Received second honorary doctorate – this one from Grand Valley State University, Allendale, Michigan.
4. Introduction The Neuman System Model provides a comprehensive, flexible, holistic, and systems-based perspective for nursing. This conceptual model of nursing focuses attention on the response of the client system to actual or potential environment stressors, and the use of primary, secondary, and tertiary nursing prevention interventions for retention, attainment, and maintenance of optimal client system wellness. – Betty Neuman (1996)
5. The Neuman Systems Model is a unique, systems-based perspective that provides a unifying focus for approaching a wide range of nursing concerns. The Neuman Systems Model is a comprehensive guide for nursing practice, research, education, and administration that is open to creative implementation… (And) has the potential for unifying various health-related theories, clarifying the relationships of variables in nursing care and role definitions at various levels of nursing practice. The multidimensionality and holistic systemic perspective of the Neuman Systems Model is increasingly demonstrating its relevance and reliability in a wide variety of clinical and educational settings throughout the world.
6. The Neuman Systems Model was originally developed in 1970 at the University of California, Los Angeles, by Betty Neuman, Ph.D., RN. The model was developed by Dr. Neuman as a way to teach an introductory nursing course to nursing students. The goal of the model was to provide a holistic overview of the physiological, psychological, socio-cultural, and developmental aspects of human beings. After a two-year evaluation of the model, it was published in Nursing Research (Neuman & Young, 1972).
7. INFLUENCES Neuman’s model was influenced by a variety of sources, but most particularly: The philosophy of writers such as • deChardin • Gestalt theory Hans Selye’s • General Adaptation Syndrome • General Systems Theory
8. Pierre Tielhard deChardin was a Catholic priest and scientist who is credited with first proposing the idea of spiritual evolution. He believed that spiritually, humans are evolving toward an ultimate perfection that he called the Omega Point. He is most often associated with the idea of a mind mesh, the interconnectedness of human spirit and mind, similar to Carl Jung’s collective unconscious.
9. Gestalt Theory is a theory of German origin that centers around the concept of the Gestalt or the whole. It emphasizes the primacy of the phenomenal (the perceived), asserting that the human world of experience is the only immediately given reality. The dynamic interaction of the individual and the situation determines experience and behavior (meaning that no two interactions will ever be the same and we should not simplistically over generalize).
10. The General Adaptation Syndrome is quite pervasive and even taught to high schoolers in their health class. It postulates that there is a nonspecific response to stress involving three stages: 1) alarm, 2) resistance, 3) exhaustion. In the first stage, the body gears up in preparation to deal with the stressor. In the second stage, the body seeks to return to homeostasis-a resting state. If stressors are not removed, then the body will not return to homeostasis, but will enter the third stage, exhaustion, in which the body function begins to breakdown.
11. General Systems Theory grew out of the field of Thermodynamics, a branch of physics, chemistry and engineering. Thermodynamics is the study of the flow of energy from one system to another. General systems theory posits that the world is made up of systems that are interconnected and are influenced by each other; systems can also be concentric with smaller systems forming a larger system. Two key assumptions are that energy is needed to maintain a high organizational state and that a dysfunction in one system will affect other systems, particularly if the dysfunctional system is a subsystem of a larger system.
12. Basic Assumptions Though each individual client or group as a client system is unique, each system is a composite of common known factors or innate characteristics within a normal, given range of response contained within a basic structure. Many known, unknown, and universal environment stressors exist. Each differs in its potential for disturbing a clients usual stability level, or normal line of defense. The psychological, sociocultural, developmental, and spiritual – any point in time can affect the degree to which a client is protected by the flexible line of defense against possible reaction to a single stressor or a combination of stressors. Each individual client/client system, overtime, has evolved a normal line of defense, or usual wellness/stability state.
13. When the cushioning, accordion like effect of the flexible line of defense is no longer capable of protecting the client/client system against environment stressor, the stressor breaks through the normal line of defense. The interrelationships of variables – physiological, psychological, sociocultural, developmental, and spiritual- determine the nature and degree of the system reaction or possible reaction to the stressors. The client, whether in a state of wellness or illness, is a dynamic composite of the interrelationships of variables – physiological, psychological, sociocultural, developmental, and spiritual. Wellness is on a continuum of available energy to support the system in its optimal state.
14. Implicit within each client system is a set of internal resistance factors known as lines of resistance, which function to stabilize and return the client to the usual wellness state (normal line of defense) or possibility to a higher level of stability following an environmental stressor reaction. Primary prevention relates to general knowledge that is applied in client assessment and intervention in identification and reduction or mitigation of risk factors associated with environmental stressors to prevent possible reaction.
15. Secondary prevention relates to the symptomatology following a reaction to stressors, appropriate ranking of intervention priorities, and treatment to reduce their noxious effects. tertiary prevention relates to the adjustive process taking place ass reconstitution begins and maintenance factors move the client back in a circular manner toward primary prevention. The client is in dynamic constant energy exchange with the environment.
16. THE SYSTEM MODEL Neuman’s model is just that-a model, not a full theory. It is a conceptual framework, a visual representation, for thinking about humans and nurses and their interactions. The model views the person as a layered, multidimensional whole that is in constant dynamic interaction with the environment. The layers represent various levels of defense protecting the core being. The two major components in the model are stress reactions and systemic feedback loops. Client reacts to stress with lines of defense and resistance (Neuman, 1995). Continuous feedback loops fine-tune the lines of defense and resistance so as to achieve maximal level of stability. The client is in continuous and dynamic interaction with the environment. The exchanges between the environment and the client are reciprocal (each one is influenced by the other). The goal is to achieve optimal system stability and balance. Prevention is the main nursing intervention to achieve this balance. Primary, secondary, and tertiary prevention activities are used to attain, retain, and maintain system balance (George, 1996
17. Each layer, or concentric circle, of the Neuman model is made up of the five person variables. Ideally, each of the person variables should be considered simultaneously and comprehensively. Physiological – refers of the physicochemical structure and function of the body. Psychological – refers to mental processes and emotions. Sociocultural – 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.
18. CONCENTRIC CIRCLE OF NEUMAN’S MODEL Central Core: Basic survival factors Flexible Lines of Defense: outer barrier Normal Line of Defense: stability in the system Lines of Resistance : protect the basic structure
19. Central Core The basic structure, or central core, is made up of the basic survival factors that are common to the species (Neuman, 1995, in George, 1996). These factors include: system variables, genetic features, and the strengths and weaknesses of the system parts. Examples of these may include: hair color, body temperature regulation ability, functioning of body systems homeostatically, cognitive ability, physical strength, and value systems. The person’s system is an open system and therefore is dynamic and constantly changing and evolving. Stability, or homeostasis, occurs when the amount of energy that is available exceeds that being used by the system. A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance.
20. Flexible Lines of Defense The flexible line of defense is the outer barrier or cushion to the normal line of defense, the line of resistance, and the core structure. If the flexible line of defense fails to provide adequate protection to the normal line of defense, the lines of resistance become activated. The flexible line of defense acts as a cushion and is described as accordion-like as it expands away from or contracts closer to the normal line of defense. The flexible line of defense is dynamic and can be changed/altered in a relatively short period of time.
21. Normal Line of Defense The normal line of defense represents system stability over time. It is considered to be the usual level of stability in the system. The normal line of defense can change over time in response to coping or responding to the environment. An example is skin, which is stable and fairly constant, but can thicken into a callus over time.
22. Lines of Resistance The lines of resistance protect the basic structure and become activated when environmental stressors invade the normal line of defense. Example: activation of the immune response after invasion of microorganisms. If the lines of resistance are effective, the system can reconstitute and if the lines of resistance are not effective, the resulting energy loss can result in death.
23. Reconstitution Reconstitution is the increase in energy that occurs in relation to the degree of reaction to the stressor. Reconstitution begins at any point following initiation of treatment for invasion of stressors. Reconstitution may expand the normal line of defense beyond its previous level, stabilize the system at a lower level, or return it to the level that existed before the illness.
24. Stressors The Neuman Systems Model looks at the impact of stressors on health and addresses stress and the reduction of stress (in the form of stressors). Stressors are capable of having either a positive or negative effect on the client system. A stressor is any environmental force which can potentially affect the stability of the system: they may be: • Intrapersonal – occur within person, e.g. emotions and feelings • Interpersonal – occur between individuals, e.g. role expectations • Extra personal – occur outside the individual, e.g. job or finance pressures
25. Prevention Primary Primary prevention occurs before the system reacts to a stressor. On the one hand, it strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors, and on the other hand manipulates the environment to reduce or weaken stressors. Primary prevention includes health promotion and maintenance of wellness. Secondary Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing systems. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor. Tertiary Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.
26. BASIC STRUCTURE PRIMARY PREVENTION •BASIC FACTORS •REDUCE POSSIBILITY COMMON TO ALL OF ENCOUNTER WITH ORGANISM i.e. STRESSORS NORMAL TEMP. RANGE •STRENGTHEN FLEXIBLE GENETIC STRUCTURE STRESSOR STRESSORS LINE •IDENTIFIED RESPONSE PATTERN •CLASSIFIED AS TO KNOWS STRESSOR ORGAN STRENGTH WEAKNESS OR POSSIBILITIES i.e. EGO STRUCTURE LOSS KNOWNS OR PAIN SENSORY DEPRIVATION COMMONALITIES CULTURAL CHANGE INTRA INTER PERSONAL SECONDARY EXTRA FACTORS Basic PREVENTION •EARLY CASE FINDING Structure •TREATMENT OF Energy SYMPTOMS sources REACTION REACTION reconstitution •INDIVIUAL INTERVENING VARIABLES, i.e. BASIC STRUCTURE IDIOSYNCRASIES NATURE AND LEARNING RESISTANCE TIME OF ENCOUNTER WITH STRESSOR TERTIARY PREVENTION •READADAPTATION STRESSORS •REEDUCATION TO •MORE THAN ON STRESSORS INTRA PREVENT FUTURE COULD OCCUR INTER PERSONAL OCCURENCES •SAME STRESSORS COULD VARY EXTRA FACTORS •MAINTENANCE OF AS TO IMPACT OR REACTION STABILITY •NORMAL DEFENSE LINE VARIES INTERVENTIONS WITH AGE AND DEVELOPMENT •CAN OCCUR BEFORE OR AFTER RECONSTITUTION RESISTANCE LINES ARE •COULD BEGIN AT ANY DEGREE RECONSTITUTION PHASES •INTERVENTIONS ARE BASED ON: OR LEVEL OF REACTION •RANGE OF POSSIBILITY MAY DEGREE OF REACTION EXTEND BEYOND NORMAL LINE RESOURCES OF DEFENSE GOALS ANTICIPATED OUTCOME INTRA INTER PERSONAL EXTRA FACTORS
27. META PARADIGM Person The person is a layered multidimensional being. Each layer consists of five person variables or subsystems: • Physical/Physiological • Psychological • Socio-cultural • Developmental • Spiritual
28. The layers, usually represented by concentric circle, consist of the central core, lines of resistance, lines of normal defense, and lines of flexible defense. The basic core structure is comprised of survival mechanisms including: organ function, temperature control, genetic structure, response patterns, ego, and what Neuman terms knowns and commonalities. Lines of resistance and two lines of defense protect this core. The person may in fact be an individual, a family, a group, or a community in Neuman’s model. The person, with a core of basic structures, is seen as being in constant, dynamic interaction with the environment. Around the basic core structures are lines of defense and resistance (shown diagrammatically as concentric circles, with the lines of resistance nearer to the core. The person is seen as being in a state of constant change and-as an open system-in reciprocal interaction with the environment.
29. Environment The environment is seen to be the totality of the internal and external forces which surround a person and with which they interact at any given time. These forces include the intrapersonal, interpersonal and extrapersonal stressors which can affect the person’s normal line of defense and so can affect the stability of the system. The internal environment exists within the client system. The external environment exists outside the client system. Neuman also identified a created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness.
30. Health Neuman sees health as being equated with wellness. She defines health/wellness as \”the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman, 1995)\”. As the person is in a constant interaction with the environment, the state of wellness (and by implication any other state) is in dynamic equilibrium, rather than in any kind of steady state. Neuman proposes a wellness-illness continuum, with the person’s position on that continuum being influenced by their interaction with the variables and the stressors they encounter. The client system moves toward illness and death when more energy is needed than is available. The client system moves toward wellness when more energy is available than is needed.
31. Nursing Neuman sees nursing as a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor. The person is seen as a whole, and it is the task of nursing to address the whole person. Neuman defines nursing as actions 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. Neuman states that, because the nurse’s perception will influence the care given, then not only must the patient/client’s perceptions be assessed, but so must those of the caregiver (nurse). The role of the nurse is seen in terms of degrees of reaction to stressors, and the use of primary, secondary and tertiary interventions.
32. Neuman envisions a 3-stage nursing process: • Nursing Diagnosis – based of necessity in a thorough assessment, and with consideration given to five variables in three stressor areas. • Nursing Goals – these must be negotiated with the patient, and take account of patient’s and nurse’s perceptions of variance from wellness • Nursing Outcomes – considered in relation to five variables, and achieved through primary, secondary and tertiary interventions.
33. NEUMAN’S WORK AND THE CHARACTERISTICS such a way as to create a different OF A THEORY o Theories can interrelate concepts in way of looking at a particular phenomenon. o Theories must be logical in nature o Theories should be relatively simple yet generalizable. o Theories can be bases for hypotheses that can be tested. o Theories contribute to and assist in increasing the general body of knowledge with the discipline through the research implemented to validate them. o Theories can be utilized by the practitioners to guide and improve their practice. o Theories must be consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated