BETTY NEUMANN’S THEORY

Moderator Mr. L. Gopichandranan lecturer CON AIIMS

PRESENTATED BY MR. MAHESH KUMAR SHARMA M.SC. NURSING 1ST YEAR

CON AIIMS

BETTY NEUMANN’S SYSTEM MODEL

• Betty Neumann’s system model provides a comprehensive, flexible, holistic

and system based perspective for nursing.

• It focuses attention on the response of the client system to actual or potential

environmental stressors.

BETTY NEUMANN’S SYSTEM MODEL

• The use of primary, secondary and tertiary nursing prevention intervention for retention, attainment, and maintenance of optimal client system wellness.

HISTORY AND BACKGROUND OF THE THEORIST

• Betty Neumann was born in 1924, in Lowel, Ohio.

• Completed B.Sc. nursing in 1957, and M.S. in Mental

Health Public health consultation, from UCLA in 1966.

• She holds a Ph.D. in clinical psychology.

HISTORY AND BACKGROUND OF THE THEORIST

• A pioneer in the community mental health movement in the late

1960s.

• Began developing her health system model, while a lecturer in

community health nursing at University of California, Los Angeles.

HISTORY AND BACKGROUND OF THE THEORIST

• The models was initially developed, in response to graduate nursing students expression of a need for course content, that would expose them to breadth of nursing problems, prior to focusing on specific nursing problem areas.

HISTORY AND BACKGROUND OF THE THEORIST

• 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, in 1974, and in the

second edition in 1980.

DEVELOPMENT OF THE MODEL

• Neumann’s model was influenced by a variety of sources.

• The philosophy writers de Chardin and cornu (on wholeness in

system).

• Von Bertalanfy, and Lazlo on general system theory.

• Selye on stress theory.

• Lararus on stress and coping.

NEUMANN’S WORK & THE CHARACTERISTICS OF A THEORY

• Theories can be the bases for hypotheses, that can be tested.

• Theories contribute to and assist in, increasing the general body

of knowledge within the discipline, through the research

implemented to validate them.

NEUMANN’S WORK & THE CHARACTERISTICS OF A THEORY

• Theories connects the interrelated concepts in such a way, as to

create a different way of looking at a particular phenomenon.

• Theories must be logical in nature .

• Theories should be relatively simple yet generalizable.

NEUMANN’S WORK & THE CHARACTERISTICS OF A THEORY

• Theories can be utilized by the practitioner, to guide and improve

their practice.

• Theories must be consistent with other validated theories, laws

and principles but will leave open unanswered questions, that

need to be investigated.

BASIC ASSUMPTIONS OF

NEUMANN’S THEORY

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BASIC ASSUMPTIONS

1. Each client system is unique, a composite of factors and characteristics within a given range

of responses contained within a basic structure.

I am unique

BASIC ASSUMPTIONS

2. Many known, unknown and universal stressors exist.Each differ in it’s potential for disturbing a client’s usualstability level or normal Line of Defense.

3. Stressors both universal and known; some are unique tothe client. They have potential to disturb equilibrium, thuscausing a change in priority of needs at any given moment.

BASIC ASSUMPTIONS

Stressors disturbs the normal equilibrium

BASIC ASSUMPTIONS

4. Man is a composite of the interrelationship of the fourvariables ( biological, psychological, socio-cultural anddevelopmental) which are at all times present.

BASIC ASSUMPTIONS

5. Each client/ client system has evolved a normal range of responses

to the environment that is referred to as a normal Line of Defense.

The normal Line of Defense can be used as a standard from which

to measure health deviation.

BASIC ASSUMPTIONS

6. When the flexible Line of Defense is no longer capable of protecting

the client/ client system, against an environmental stressor, the

stressor breaks through the normal Line of Defense.

Primary Prevention

Secondary Prevention

Tertiary Prevention

BASIC ASSUMPTIONS

8.Primary prevention relates to general knowledgeapplied to clients assessment to identify stressorsbefore they occur.

9.Secondary prevention relates to symptomatology.These are interventions generally initiated after anencounter with a stressor.

10.Tertiary prevention relates to the adaptive process, asreconstitution begins and moves back towards primaryprevention. These are the interventions initiated aftertreatment.

BASIC ASSUMPTIONS

MAJOR CONCEPTS OF NEUMANN'S

THEORY

FOUR MAJOR CONCEPTS

Person

Environment

Health

Nursing

1.PERSON

Each layer consists of five person variable or subsystems:

Physiological- Refer to the physiochemical 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.

2.ENVIRONMENT

The internal environment exists within the client system.

The external environment exists outside the client system.

A created environment which is an environment that is created and

developed unconsciously by the client and is symbolic of system

wholeness.

3.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 (Neumann, 1995)”.

3.HEALTH

The client system moved towardwellness when more energy isavailable than is needed.

The client system moves toward illnessand death when more energy isneeded than is available.

.

4. 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.

4. NURSING

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.’’

4. NURSING • The role of the nurse is seen in terms of degree of reaction to stressors, and

the use of primary, secondary and tertiary interventions.

Primary Prevention

Secondary Prevention

Tertiary Prevention

Primary prevention

Secondary prevention

Tertiary prevention

Stressors

Reaction

Interventions

Reconstitution

Stressors

Stressors

Basic structure and Line of

Defense

The Neuman System Model (3 rd edition, 1995)

STAGES OF NURSING PROCESS (BY NEUMAN)

Nursing

DiagnosisNursing Goal

Nursing

Outcome

STAGES OF NURSING PROCESS (BY NEUMAN)

1. NURSING DIAGNOSIS

• It depends on acquisition of appropriate database; the diagnosis identifies, assesses,classifies, and evaluates the dynamic interaction of the five variables.

• Variances from wellness (needs and problems) are determined by correlations andconstraints through synthesis of theory and data base.

• Broad hypothetical interventions are determined, i.e. maintain flexible line ofdefense.

STAGES OF NURSING PROCESS (BY NEUMAN)

2. NURSING GOALS

• These must be negotiated with the patient, and take account of patient’s andnurse’s perceptions of variance from wellness.

3. NURSING OUTCOMES

• Nursing intervention using one or more preventive modes.

• Confirmation of prescriptive change or reformulation of nursing goals.

• Short term goal outcomes influence determination of intermediate and long– term goals.

• A client outcome validates nursing process.

NEUMANN’S SYSTEM MODEL FORMAT

ACCEPTANCE BY THE NURSING COMMUNITYPRACTICE

EDUCATION

RESEARCH

ADMINISTRATION

PRACTICE

FAMILY THERAPY, PUBLIC HEALTH, REHABILITATION, AND HOSPITAL

NURSING.

THE SUB SPECIALTIES

INCLUDE PULMONARY,

RENAL, CRITICAL CARE, AND

HOSPITAL MEDICAL UNITS.

•As a curriculum guide for a

conceptual framework oriented

more toward wellness than toward

a medical model and has been used

at various levels of nursing

education.

•Developing a frame of reference

centered on holistic care.

EDUCATION

•The identification of congruence between the client’s perception of stressors and the Method of collecting and analyzing data for identifying client problems.

care giver’s perception of client stressors.

RESEARCH

• Case management of patients.

• Total quality management is used to prepare health care administrators for future.

ADMINISTRATION

NEUMAN’S SYSTEM MODEL CONCEPT MAP:

NEUMAN’S SYSTEMS MODEL CONCEPT

MAP

CLIENT

SPIRITUALPHYSIO

LOGICAL

DEVELOP

MENTAL

PSYCHO

LOGICAL

SOCIO

CULTURAL

CLIENT SYSTEM

CENTRAL CORE

FLEXIBLE LINES

NORMAL LINES

LINES OF RESISTANCE

ENVIRONMENT

INTERNALEXTERNAL

CREATED

HEALTH

WELLNESS ILLNESS

NURSING

PREVENTION

PRIMARY

SECONDARY

TERTIARY

NURSING PROCESS

DIAGNOSIS

GOALS

OUTCOMES

STRESSORS

INTRAPERSONAL INTERPERSONAL EXTRAPERSONAL

SUMMARY

Introduction of theory

History and background of theorist

Development of model

Characteristics of theory

Basic assumptions

Major concepts

Applications in nursing practice