2. The Neuman Systems Model

3. “The Neuman Systems Model is a unique, open systems-based perspective that provides a unifying focus for approaching a wide range of international health concerns” (Betty Neuman, 2008, taken from www.neumansystemsmodel.org). Neuman’s model is a conceptual framework used for thinking about client and nurse interactions. The Neuman Systems Model (NSM) utilizes a holistic perspective which allows a broad use of creativity by nurses in its use, and we believe it is very flexible and has the staying power for its use well into the future.

4. The NSM focuses on the client (individual, family, group, or community) as a system and on their responses to stressors. The model views humans as layered, multidimensional wholes that are in constant dynamic interaction with the environment. Humans in the NSM are described as having concentric rings that include lines of resistance or defense (Skalaski, DiGerolamo, & Gigliotti, 2006, p. 70). The model suggests the use of three levels (primary, secondary, and tertiary) of nursing prevention for the maintenance of optimal client system wellness (taken from currentnursing.com).

5. Assist the client in promoting health by strengthening their lines of defense and resistance. “For the nurse, it is important to understand not only the impact of the stressor but also the system’s response” (Gehrling & Memmott, 2008, p. 135). When nurses understand the connection between the client and their environment, they have a better chance in helping the client maintain their state of health and increase their wellness.

6. Born in 1924, in Lowell, Ohio Ph.D. in clinical psychology, UCLA Pioneer in community mental health movement Published NSM in 1972 Influenced by de Chardin, Cornu, VonBertalanfy, Lazlo, Selye, and Laraus (currentnursing.com [history and background of theorist])

7. Original title Neuman developed the systems model for use by her graduate students “the promotion of holistic health through education and curriculum consultation for programming within national and international universities and health care facilities using the Neuman System Model developed in 1970”. (Betty Neuman, 2008, taken from www.neumansystemsmodel.org)

8. Leader of Neuman Systems Group -Model Consultant -Educator -Author -Lecturer -Private practice health consultant (neumansystemsmodel.org [trustees, current positions])

9. Nursing theory has been defined as “the set of concepts, definitions, and propositions that project a systematic view of phenomena by designating specific inter- relationships among concepts for the purpose of describing, explaining, and predicting phenomena” (Adams, 1991. p. 1487). Neuman Systems Model

10. Global Concepts Human Being EnvironmentHealthNursing Their relationship together is linked as essential concepts of the model. It takes all four global concepts to make the content of the nursing model.

11. Nursing is defined as being concerned with the “whole” person and all the variables affecting an individual’s response to stressors. The opinion nurses assume defines what care is given.

12. Clients outside stressors are to be considered when treating the whole client. The person can be an individual, family, group, community, or social issue. It is seen being in a state of constant change with interaction with the environment.

13. The environment is considered all the factors (internal and external) that surround the client. Neuman identifies three relevant environments: internal, external, and created (Freese & Lawson, 2005. p.316). The internal is intrapersonal, within the client system. The external is all factors outside the client. The created environment is established and developed unconsciously by the client and is symbolic of system wholeness. Concept according to Neuman

14. Health is wellness and is defined “as the condition of optimal stability of the client/client system” (Tourville, Ingalls, 2003. p.26). The client moves toward illness and death when more energy is needed that is available, and moves toward wellness when more energy is available than is needed. (Betty Neuman, 2008, taken from www.neumansystemsmodel.org).

15. Focused on nursing, but includes all scopes: Nursing practice Education Research Influenced by variety of sources: deChardin-A priest that believed human beings are continually evolving towards a state of perfection. Gestalt theory-Proposed that the dynamic interaction of the individual and the situation determines experience and behavior. General Adaption Syndrome- Individuals reaction to stress by: alarm, resistance, and exhaustion. General Systems Theory- world is made up of systems that are interconnected and influenced by others (taken from patheyman.com)

16. Four global concepts: Nursing Human Being Environment Health is wellness Can be adapted to all different scopes of nursing, based on three steps: Assessment Intervention Evaluation (Freese & Lawson, 2005, p.322)

17. Many people have stressors in their lives that inhibit healing. The client shall be an active participant in setting goals and selecting interventions. When a patient is admitted to the hospital with uncontrolled hypertension, the nurse needs to look at the whole picture. Does the patient have stressors that are contributing to this, such as money difficulties, family issues, or lack of education regarding his/her condition? If a patient is admitted with contractions at week 30, is there underlying stress causing this such as marital issues or job stress?

18. Having been influenced by many great philosophers, The Neuman Systems Model was born. The model is an effective framework for the practice of nursing wherein the person is an open system with interrelated parts, maintaining balance and harmony between the environment by adjusting to stress and defending against tension-producing stimuli. The nursing profession is primarily concerned with the effects of stress on health. They focus on the patient’s stress and interventions for reductions to regain stability in the system. While recognizing lines of resistance, as a facilitator in coping with stress, adaption occurs creating a protective barrier for change thus regaining stability in the open system by inclusion of the four metaparadigms of nursing. The model goes beyond the scope of nursing to include multidisciplinary collaboration for prevention including primary, secondary, and tertiary to attain balance and harmony in the environment. Neuman Systems Model is: broad, provides guidelines for nurses to practice quality of care for the patient by attaining wellness through prevention and interventions of stress, adaptable by many health care settings, applicable to the future of nursing practice, and research that will improve new knowledge for the enhancement of nursing practice. Betty Neuman’s, “holistic was changed to wholistic” in reference to the whole person much as the nursing profession should challenge themselves to the Shakespearean quote, “To be or not to be: that is the question.” (Alligood & Tomey, 2010, pp. 309-323)

19. Betty Neuman System Model

20. Name-Emma J. Age- 37 years Sex- Female Marital Status-Divorced, receiving some child support Job-Fulltime employment Spiritual Children-2 (ages 10 &12) Next of Kin-Mother Sustained Injuries from car accident-fractured right leg, bilateral wrists, and lacerations to face Hospitalized on 6/30/10, surgical placement of pins and plates in leg, bilateral arms casted, and sutured lacerations Discharged 7/10/10 with medications: Vicodin 5/500 mg q 6 hours PRN and Ibuprofen 800 mg q 6 hours PRN Homecare implemented 7/13/2010

21. Acute pain Unable to ambulate, wheelchair bound Extending healthcare- physical therapy after casts removed Unable to perform ADL’s-acquires assistance Depression-Emma reports, “feeling of powerlessness” due to the accident and the inability to care for herself. Guilt-Emma reports, “ I feel guilty for relying on my family and friends for care.” Concerns related to financial burden’s include: insurance coverage of all expenses and unable to work to support family Visits from friends, co-workers, minister, and fellowship members who assist in housework and cooking. Caregiver role strain-between Emma, mother, and ex-husband helping with children

22. As the nurse, what do you assess as Emma’s stressors? A. Financial difficulties B. Emotional state C. Inability to fulfill prior roles D. Supportive family E. Strength in faith F. A,B and C G. All of the above Rationale: “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 The person has a certain degree of reaction to any given stressor at any given time. The nature of the reaction depends in part on the strength of the lines of resistance and defense. By means of primary, secondary and tertiary interventions, the person (or the nurse) attempts to restore or maintain the stability of the system.”

23. Caregiver role strain related to inability to fulfill prior role, never been in a situation where she was unable to care for her family and mother and ex-husband’s assistance makes Emma feel that she is failing Acute pain-controlled by medications, Emma reports’ “administration of Ibuprofen three times daily, occasional Vicodin” Ambulating short distances in home by using the left foot to propel the wheelchair Transfers with assistance Improved mood since hospitalization, beginning to have hope Emma reports, “majority of my stressors are related to the financial aspects of my illness” and nurse notes Emma able to recognize positive stressors.

24. What interventions, would you, as the nurse put in place? A. Adaptive equipment B. List of resources C. Exercises D. Counseling E. Nursing home placement F. A,B,C and D G. All of the above Rationale: Current needs are being met by: adaptive equipment, list of resources, exercises, and counseling as interventions. Nursing home placement is presumptuous as an intervention.

25. Healthcare Nurse List of outside resources for assistance Adaptive equipment to foster independence with ADL’s Exercises to perform while wheelchair bound-will maintain muscle strength and increase positive mood Family, Church, Work, and School Consultation with minister has reduced depression symptoms Church volunteers sitting with Emma to relieve mother Children attended youth groups for recreation and expression of their feelings School-raised money and food donations for the family Short term disability benefits from employer received

26. Presented By: Audra Parmer Kara Elkins Amy Brown M. Susan Nason Melissa Burleson

27. Adams, T. (1991). The idea of revolution in the development of nursing theory. Journal of Advanced Nursing, 16(2), p. 1487. doi: 10.1111lj.1365- 2648.1991.tb01597.x Alligood, M. R., & Tomey, A. M. (2010). Nursing Theorists and Their Work. Maryland Heights: Mosby Elsevier. Freese, B. & Lawson, T. (2005).Betty Neuman: Systems Model. In Tomey, M.A. & Alligood, M.R. (Eds.) Nursing Theorists and their Work (7th ed.) (pp.309- 323). Mosby. Gehrling, K. R., & Memmott, R. J. (2008). Adversity in the context of the Neuman systems model. Nursing Science Quarterly, 21(2), 135-136. doi: 10.1177/0894318408316405 Haggart, M. (1993). A critical analysis of Neuman’s systems model in relation to public health nursing. Journal of Advanced Nursing, 18, 1917-1922. Neuman Systems Model. (2000). Betty Neuman’s System Model. Retrieved October 27, 2010, from http://www.patheyman.com/essays/Neuman/index.htm.

28. Neuman Systems Model. (2010). About Neuman system model, Inc. Retrieved October 22, 2010, from http://neumansystemsmodel.org/ Nurses Info, Information and Resources for Nurses Worldwide, (2010). Betty Neuman, Retrieved from http://nurses.info/nursing_theory_person_neuman_betty.htm Nursing Theorists. (2010). Betty Neuman’s System Model. Retrieved October 22, 2010, from http://currentnursing.com Skalski, C. A., DiGerolamo, L., & Gigliiotti, E. (2006). Stressors in five client populations: Neuman system model-based literature review. Journal of Advanced Nursing, 56(1), 69-78. doi: 10.1111/j.1365-2648.2006.03981.x Tourville, C. & Ingalls, K. (2003). The Living Tree of Nursing Theories. Nursing Forum, 38(3), p. 26. doi: 10.1111/j.0029-6473.2003.t01-1-00021.x Understanding the Work of Nurse Theorists, (2004). Betty Neuman’s System Model, Retrieved from http://nursing.jbpub.com/sitzman/artGallery.cfm