Nursing Care System and Neumann Model
Neumann Systems Model
The Neuman Systems Model (NSM) provides a broad, comprehensive, systems approach as a framework for the nursing profession to organize care, educate future providers, and conduct research. The model offers a holistic approach, a wellness orientation, client perception, and motivation with a systems perspective of variable interaction with the environment (Neuman, 2001, p. 12).
The model's philosophical and theoretical underpinnings include: von Bertalanffy's (1968) general systems theory, De Chardin's (1955) philosophical views of the wholeness of life, gestalt theory and its focus on perception (Pearls, 1973) and field theory (Edelson, 1970) , and the typology of prevention interventions (Caplan, G., 1964).
Additionally, Seyle's (1950) theory of stress and adaptation and Lazarus and Folkman's (1984) theory of stress and coping were foundational to the development of the NSM.
Consequently, two components undergird much of the focus of the model:
exploring the client's response to stressors, and identifying the nurse's
preventive interventions that assist the client in responding to these
stressors. The ultimate goal of the unique profession of nursing is to assist
the client in achieving the goals of an optimum state of wellness.
Neuman System Model and Nursing Graduates
Betty Neuman first developed the Neuman Systems Model to assist
graduate students at the University of California, Los Angeles, to
conceptualize a systems approach to health care. It is based on Neuman's
personal philosophy shaped by the philosophical and theoretical tenets
mentioned previously, and her experience as a consultant in public health and
community mental health nursing (Walker, PH, 2004). It was developed in 1970
and is used by practitioners, educators, and increasingly by researchers
nationally and internationally.
Purpose of Model
The main concepts of the NSM are consistent with those of the nursing metaparadigm which undergird most of the other grand theories in nursing: person, environment, health, and nursing.
Within the context of the nursing metaparadigm, the primary components of the NSM include: stressors, lines of defense and resistance, levels of prevention, the five client systems variables (basic structure, interventions, internal and external environment, and reconstitution).
All concepts have been defined by Neuman in each of his
texts (Neuman, 1982, 1989, 1995, 2001).
What is Nursing According to Neuman System Model
Neuman describes nursing as a “unique profession” concerned with the interrelationship of “all variables affecting a client's possible or actual response to stressors. Thus, nursing uniqueness is related to the way the discipline organizes and utilizes its knowledge (Neuman, 1989, p. 24).
The
nurse is an intervener who uses three levels of prevention (primary, secondary,
and tertiary) to achieve the goal of reducing the client's encounter with
stressors and/or mitigating the impact of the stressor. The ultimate goal is to
help the client system retain stability.
Concerns of Neuman System Model
The client or client system is the term Neuman uses for person, because the focus of the model is wellness and fostering a collaborative relationship between the client and the caregiver (the nurse, in this case).
The client or client system may be an individual, group, family, and/or community and is composed of five interrelated variables (physiological, psychological, sociocultural, developmental, and spiritual).
The spiritual variable was added to the model in 1989 to be more consistent with Neuman's holistic belief about humans (Neuman, 1989). These variables are surrounded by various lines of defense and resistance.
According to Neuman, a client's normal line of defense is dynamic, evolves over time, and contains the client's normal range of responses to stressors, thereby reflecting his or her usual wellness level (Neuman, 2001, p. 18).
Furthermore, the client or client system has
internal lines of resistance which function to protect the client's basic
structure or system integrity which, if ineffective, will result in system
energy depletion and eventually death (Neuman, 2001, p. 18).
What is Environment According to Neuman System Model
Environment, according to Neuman consists of internal, external and created environment(s). The internal environment is composed of forces within the client identified by Neuman as intrapersonal stressors. Other stressors (interpersonal and extra personal) make up the external environment.
The
concept of a created environment was also added in 1989, again to reflect
Neuman's holistic perspective and beliefs. The created environment is
considered to be unconsciously developed by the client in order to protect the
client from intra, inter, and extra personal stressors and maintain system
stability (Neuman, 1989, p. 12).
What Is Health According to Neuman System Model
Health, according to Neuman is equated with living energy,
determined by the degree of harmony among the five client variables and basic
structure factors, on a continuum from wellness to illness. The degree of
wellness is determined by the amount of energy required to retain, attain, or
maintain system stability (Neuman, 2001, p. 12).
Applications of Neuman System Model
Although the NSM has been used widely in practice and education, it is increasingly being used in the research community, particularly by students in masters and doctoral programs.
An integrative review of NSM-based research conducted by Fawcett and Giangrande (2001) found 200 research reports with an analysis focused on general information, scientific merit, and the NSM.
The majority of the 200 studies were related to clinical nursing topics (75%), followed by nursing administration (14%), nursing education (9%), with the least on continuing education (2%).
The fact that much of the research is related to practice-oriented questions hopefully begins to address concerns by PH Walker and Redman (1999) that evidence-based practice may be threatening the foundation of nursing's disciplinary perspective on theory-guided practice.
Analysis of the scientific merit revealed the following: 37% were descriptive studies, 32% were experimental studies, 25% were correlation studies, and approximately 4% were designed to develop and test instruments (Fawcett & Giangrande , 2001, p. 124).
A summary of the analysis of elements related to
the NSM indicated: most frequently, development of testing of prevention as
intervention; next, 24% explored perception of stressors; 9% were studies
involving client variables; and only a few studies (1% to 5%) were on lines of
defense and/or resistance.
Neuman Model Instruments
In reference to use of instrumentation, Gigliotti and Fawcett (2001) reviewed 212 research reports and identified different instruments explicitly linked to the NSM-sometimes more than once, and for different purposes.
These instruments included: Beck Depression Inventory, State Trait Anxiety Inventory, the Norbeck Social Support Questionnaire, the Dynamap , the Carter Center Institute Health Risk Appraisal, and the Health Status Questionnaire.
In an important evaluation of instrumentation related to middle range theory, Gigliotti and Fawcett found that 26 instruments measured concepts related to stressors, 24 measured concepts related to lines of defense, and 22 measured prevention interventions, Other NSM-related concepts (middle-range) were measured by the remaining 16 instruments.
Of those instruments, 59 were classified as standardized (having sufficient evidence of validity and reliability testing) and 62 were considered non-standardized (Gigliotti & Fawcett, pp. 153-154).
Use In Evidence Based Practice
To enhance and facilitate future research related to the NSM, Neuman and Fawcett (2001) have established a set of guidelines for NSM-based research. Additionally, Fawcetand Giangrande (2001, pp. 136-137) encourage collaborative research and cluster studies which would look at related phenomena.
For example, one researcher might explore the impact of inter- or extra-personal stressors on some of the five variables while another researcher could study the impact of intra- or interpersonal stressors on the same variables using the same sample of study participants.
Finally, Gigliotti and
Fawcett (2001, pp. 166-169) concluded that more attention should be paid to
validity of existing instrumentation and to the examination of the utility of
instruments used in NSM-based clinical practice with an eye to the research
potential of clinical and educational tools.
Give your opinion if have any.