Neuman Systems Model

Roline CampbellRoxy JohanningTracy 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)

“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, 2002Betty Neuman as keynote speaker at the University of Maine, Fort Kent in 2004.

An Overview of the Neuman Systems

Model

Philosophical Claims

o Wholismo Wellness orientationo Client perception and motivationo Dynamic systems perspective of energy & variable interaction with the environmento Client & caregiver in partnership

Key ConceptsClassified 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• Reconstitutio

n

Nursing

• Prevention as Intervention

Client/Client Systemo Viewed as open systemo Repeated cycles of input, process,

output & feedbacko Thus a dynamic organizational patterno Can be• Individual• Family• Group• Community• Aggregate (Social Issue)

Interacting Variables

SpiritualPsychologicalPhysiologicalSocio-culturalDevelopmental

Present in each type of client

Consider thesesimultaneously & comprehensively

Basic survival factors

Normal temp rangeGenetic StructureResponse pattern

Organ strength/weakness

Ego structure

Central Core

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

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

IntrapersonalStressors

External Environment

Forces & interaction influences

existing outside the client system Extra-personal stressors

Interpersonal

stressors

Created Environment

Symbolic expression of

system wholeness

Unconscious mobilization of all system variables

Interpersonal

Intrap

erso

nalExtra-

personal

Wellness and IllnessOptimal 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 Interventiono Basis for health promotiono Nursing is prevention as interventiono Three dimensions• Primary prevention• Secondary prevention• Tertiary prevention

Primary Prevention o Health promotion & Maintenance of wellnesso Occurs before the system reacts to a stressoro 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 Coreo Occurs after the system reacts to a stressoro Aims to strengthen the Lines of Resistanceo May also try to remove the stressor

Tertiary Prevention o Occurs after the client/client system has been treated through secondary prevention strategieso Offers support to the client o Attempts to:• add energy to the system or • reduce energy needed in order to facilitate reconstitution

ReconstitutionThe determined energy increase related to

the degree of reaction to a stressorRepresents the return and maintenance of

system stability following treatmentMay be viewed as feedback from the

input/output of secondary preventionComplete 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

Jacqueline Fawcett and Betty Neuman at the 8th Neuman Systems Model Symposium

- Salt Lake City, 2001

Evaluation

of theNeuman SystemsModel

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, 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.) 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

SignificanceInternal

ConsistencyParsimonyTestabilityEmpirical

AdequacyPragmatic

Adequacy

Significance - MeetsMetaparadigm concepts & propositions

are explicitly statedAll philosophical claims are addressedSupport 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 - MeetsNSM 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 - MeetsThe 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

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

ComparisonRogers (1970)Science

of Unitary Human Beings

Neuman

(1970)Neuman’s System

Model

Roy (1970)Roy’s

Adaptation Model

Contemporaries of one another

Martha Rogers

Betty Neuma

n

Sister Callista

Roy

Each Define the Metaparadigm Concepts:PersonEnvironmentHealth Nursing

Each Used in Nursing:

PracticeAdministrationEducation

Theories derived from:Martha Rog

ers • Six

Grand theories and 12 Middle-range theories based on SUHB (Fawcett, 2005, p. 332-333) B

etty Neu

man • Two Grand Theories and Three Middle-range theories based on NSM (Fawcett, 2005, p. 184)

Sister Calli

sta Roy

• One Grand theory and Nine Middle-range theories based on RAM (Fawcett , 2005, p. 389, 392-93)

Goal of NursingTo 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)

OverviewFocus 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)

WorldviewReflects the

simultaneous action worldview

Reflects the reciprocal interaction worldview

Reflects the reciprocal interaction worldview

Reciprocal Interaction WorldviewThis 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 ViewThis world view combines elements of theorganismic, simultaneity, change and unitary-

transformative world views:Unitary human beings are identified by patternHuman beings are in mutual rhythmical

interchange with their environments Human beings change continuously,

unpredictably and in the direction of more complex self-organization

The phenomena of interest are personal knowledge and pattern recognition

(Fawcett, 2005, p. 13)

Meets Fawcett’s Criteria for Evaluation of Nursing Models

RogersRoyNeuman

(Fawcett 2005, p. 57-58)

Rogers Roy

Neuman

Selection Rationale

Discussion of the Nurse as the Client

Galloway (1993) offered an informative NSM-based self-analysis 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 forumsEstablisment 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