Betty Neuman's System Model

Betty

Neuman was born in 1924, in Lowel, Ohio. BS in nursing in 1957 MS in Mental Health Public health consultation, from UCLA in 1966. Ph.D. in clinical psychology a pioneer in the community mental health movement in the late 1960s. developed the model while working as a lecturer in community health nursing at University of California, Los Angeles. The model was published in 1972 as A Model for Teaching Total Person Approach to Patient Problems in Nursing Research. It was refined and subsequently published in the first edition of Conceptual Models for Nursing Practice, 1974, and in the second edition in 1980.

Viewed the client as an open system consisting of a basic structure or central core of energy resources

concentric circles 1. Physiological - refers of bodily structure and function. 2. Psychological - refers to mental processes, functioning and emotions. 3. Sociocultural - refers to relationships; and social/cultural functions and activities. 4. Spiritual - refers to the influence of spiritual beliefs. 5. Developmental - refers to lifes developmental processes.

Central core/ Basic Structure Energy Resources

1. 2. 3. 4. 5. 6.

Normal temperature range body temperature regulation ability Genetic structure Hair color and bodily features Response pattern functioning of body systems homeostatically Organ strength or weakness Ego structure Knowns or commonalities value system

The person's system is an open system dynamic and constantly changing and evolving y Stability, or homeostasis, occurs when the amount of energy that is available exceeds that being used by the system. y A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance
y

Flexible LOD y It is a protective, accordion like mechanism that surrounds and protects the normal LOD from invasion by stressors. y Keeps the system free from stressors and is dependent on the amount of sleep, nutritional status, as well as the quality and quantity of stress an individual experiences. y If the flexible line of defense fails to provide adequate protection to the normal line of defense, the lines of resistance become activated.

Normal LOD y The usual state of wellness. y It is considered dynamic in response to coping or responding to the environment, which includes intelligence, attitudes, problem solving and coping abilities.
Example is skin which is constantly smooth and fair will eventually form callous over times.

Line of Resistance-LOR y Protection factors activated when stressors have penetrated the normal LOD, causing a reaction symptomatology.
x E.g. mobilization of WBC and activation of immune system mechanism

Input- output y The matter, energy, and information exchanged between client and environment that is entering or leaving the system at any point in time.

Open system
yA

system in which there is continuous flow of input and process, output and feedback. It is a system of organized complexity where all elements are in interaction.

Prevention as intervention
y

Interventions modes for nursing action and determinants for entry of both client and nurse in to health care system.

Reconstitution
y

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

Stability
y

A state of balance of harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health thus preserving system integrity.

Stressors
Is any environmental force which can potentially affect the stability of the system y Intrapersonal - occur within person y Interpersonal - occur between individuals y Extrapersonal - occur outside the individual

Wellness/Illness y Wellness is the condition in which all system parts and subparts are in harmony with the whole system of the client.
y

Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002). Illness is an excessive expenditure of energy when more energy is used by the system in its state of disorganization than is built and stored; the outcome may be death (Neuman, 2002).

PREVENTION
y

the primary nursing intervention. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body.

Primary Prevention
Primary prevention occurs before the system reacts to a stressor. On the one hand, it strengthens the person (primary the flexible LOD) to enable him to better deal with stressors y Primary prevention includes health promotion and maintenance of wellness.
y

Secondary Prevention
Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing system. y Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor.
y

Tertiary Prevention
Tertiary prevention occurs after the system has been treated through secondary prevention strategies. y Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.
y

FOUR NURSING PARADIGMS

PERSON y Human being is a total person as a client system and the person is a layered multidimensional being. y Each layer consists of five person variable or subsystems:
Physiological - Refers of the physicochemical structure and function of the body. Psychological - Refers to mental processes and emotions. Socio-cultural - 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.

ENVIRONMENT y 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. y These forces include the intrapersonal, interpersonal and extra-personal stressors which can affect the persons 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. The created environment is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness.

HEALTH y Health as being equated with wellness. Health/wellness is defined as the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman, 1995). y The client system moves toward illness and death when more energy is needed than is available. The client system moved toward wellness when more energy is available than is needed

NURSING y 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. y The person is seen as a whole, and it is the task of nursing to address the whole person. y 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. y Neuman states that, because the nurses perception will influence the care given, then not only must the patient/clients perception be assessed, but so must those of the caregiver (nurse). y The role of the nurse is seen in terms of degree of reaction to stressors, and the use of primary, secondary and tertiary interventions

NeumanS SYSTEM MODEL FORMAT

ASSESSMENT y Potential and actual stressors. y Condition and strength of basic structure factors and energy sources. y Characteristics of flexible and normal line of defenses, lines of resistance, degree of reaction and potential for reconstitution. y Interaction between client and environment. y Life process and coping factors (past, present and future) actual and potential stressors (internal and external) for optimal wellness external. y Perceptual difference between care giver and the client.

NURSING DIAGNOSIS y The data collected are then interpreted to condition and formulate the Nursing diagnosis. y Health seeking behaviors. y Activity intolerance. y Ineffective coping. y Ineffective thermoregulation

GOAL
y

In Neumans systems model the goal is to keep the client system stable.

PLANNING y Planning is focused on strengthening the lines of defense and resistance

IMPLEMENTATION
y y y y

The goal of stabilizing the client system is achieved through three modes of prevention Primary prevention : actions taken to retain stability Secondary prevention : actions taken to attain stability Tertiary prevention : actions taken to maintain stability

EVALUATION
y

The nursing process is evaluated to determine whether equilibrium is restored and a steady state maintained.