H O L Y A N G E L U N I V E R S I T Y Graduate School of Nursing

In Partial Fulfillment of Requirements for GSNATFN

Betty Neumans Systems Model

Theory, Application, and Analysis

Presented To: Marietta H. Gaddi, RN, PhD

Submitted By: Joe Anne Mae A. Maniulit, RN

September 27, 2011

Neumans Systems Model BETTY NEUMAN: SYSTEMS MODEL HISTORY OF THE THEORIST Betty Neuman, a theorist credited to be a pioneer in nursing involvement in

mental health, was born in 1924 in a village in Washington Country in Lowell Ohio along the Muskingum River. She was the middle child of the family, with two brothers. At the age of eleven, her father had died from Kidney disease after several hospitalizations. From these experiences, Neumans father had always spoke highly of the nurses who cared for him, and this strongly affected her inspiration in becoming a nurse (Sitzman & Eichelberger, 2011). She grew up in a rural, farming community, which helped develop her passion for caring and helping people in need as well as having a love for the land. Having lost her father at such a young age, she could not afford to attend nursing school straight after her high school graduation, so she had worked as an aircrafts instrument repair technician, draftsperson, and a short order cook while saving for her nursing education, and helped support her mother and her two brothers as well (Sitzman & Eichelberger, 2011). She completed her initial nursing education with honors at Peoples Hospital School of Nursing (now General Hospital) in 1947 at Akron, Ohio (Tomey & Alligood, 2004). Briefly after completing this degree, she then moved to Los Angeles, California and gained experiences in a variety of nursing roles which included Hospital Staff, Head Nurse, School nurse, and industrial nursing. She was also able to gain experience in clinical teaching (in areas such as medical-surgical nursing, communicable disease, and critical care nursing) in what is now known as the University of Southern California Medical Center, in Los Angeles.

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Neumans Systems Model As she had lived in a farm, Neuman was accustomed to always helping others in need and this sparked her interest in human behavior. This interest continuously fueled her studies and her theories in the development of the Systems Model. She attended

University of California in Los Angeles (UCLA) with a double major in public health and psychology (Nicoll, 2008). She was able to complete her Bachelors of Science in Nursing in 1957, after which she helped establish and maintain her husbands medical practice (McQuiston & Webb, 2008). She received her Masters Degree in mental health and public health consultation in 1966 from the same university. She later received her doctoral degree in clinical psychology from Pacific Western University in 1985. Betty Neuman received her Honorary Doctorate of Letters from Neumann College, Aston, Pennsylvania in 1992, and her Honorary Membership in the American Academy of Nursing in the following year (Nicoll, 2008). In 1998, she received her Honorary Doctorate of Science from Grand State Valley University in Michigan (McQuiston & Webb, 2008). Dr. Neuman, who was passionate about creating her systems model, continuously worked to improve the model so that it may be integrated into the various field of nursing practice. Today, her book on the systems model currently has five revised editions, with the fifth published this year (with co-author Jacqueline Fawcett). The fourth and fifth editions of the book posed for further developments of the theory, offering an integrative review of the model for areas of nursing such as application for practice, education, research, and administration (Tomey & Alligood, 2004). The Systems Model was widely accepted, not only in the nursing community, but also in the other health disciplines because of its wide scope. This acceptance also caused

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Neumans Systems Model a magnitude of international activities inspired by the Systems Theory, as it has been cited on multiple occasions in international publications; it is the framework of many

researches, as well as the basis of post-graduate paper presentations (Tomey & Alligood, 2004). THEORY ANALYSIS Theory Creation Timeline Before Neuman had began to work on her Systems model, she developed her first teaching and practice model in the late 1960s and this model is cited in her first book publication Consultation and Community Organization in Community Mental Health Nursing (published in the spring edition in 1972). She later designed a conceptual model for nursing in 1970 the graduate students of UCLA who wanted a course emphasizing breadth (range or scope) rather than depth. The model was first created to integrate the students understanding of the variables within each client which has a wider scope than that of the medical model. The model included theories and concepts from behavioral science, which was used for problem identification and problem prevention. This model was published in 1972 in Nursing Research, and Neuman spent a decade afterwards to define and refine the various aspects of the model in preparation for her book, The Neuman Systems Model: Application to Nursing Education and Practic (Tomey & Alligood, 2004). Theoretical Sources for the Creation of the Theory Health is a condition in which all parts and subparts are in harmony with the whole of the client.

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Neumans Systems Model

The concept of the Systems Theory was born in the early 1970, during a graduate class, when it was asked, how can nurses organize vast knowledge needed to deal with complex human situations that require nursing care? (Meleis, 2011) From this question, Neuman tried her first attempt to answer with the adoption of many different theories, concepts, as well as her own philosophies of health, wellness, and the role of the nurse (Tomey &Alligood, 2011). With this, she worked at building, what she considers, a wellness-oriented model and articulated a number of assumptions about client systems, environmental stressors, their responses to stress, lines of resistance and defense, health, energy, and wellness (Meleis, 2011). Dr. Betty Neuman integrated and synthesized her knowledge of various disciplines in the creation of the model, especially those related to mental health. All in all, she used the general systems theory, the Gestalt theory, Hans Selyes definition of stress, the conceptual model of Caplan, the philosophical views of Pierre de Chardin, and Karl Marx(Tomey & Alligood, 2004). General Systems Theory Her primary basis is the use of the general systems model. A deeper view of the system defines that the world is composed of many systems, and these systems are in constant interaction with one another. In an abstract way, these systems are not just an influence, but rather, they are interrelated. The term General Systems does not necessarily have a precise definition, as it is utilized by not only the health science but other sciences as well (Checkland, 1997). However, in this theory, the term systems refers to the client holistically (or wholistically as refined in later editions of Neumans Theory), and this will be later discussed in the definitions of key terms and concepts.

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Neumans Systems Model The Gestalt Theory The Gestalt theory is one of German origin, with the term die gestalt meaning shape, essence, or a shape in its entirety or complete form. The Gestalt theory is usually defined as a whole is greater than the sum of its parts. In Psychology, the Gestalt Effect is defined as the ability of the mind to recognize whole

forms from a set of lines or curves. In the same aspect that psychologist utilizes Gestalt to seek the mind set of an individual, Neuman also uses this description to help explain the dynamic interaction between an individual and their present situation and how this interaction, in turn, defines the experience and the patients behavior. Hans Selyes General Adaptation Syndrome Focuses on the individuals reactions to stress which include alarm, resistance and exhaustion. Neuman utilizes the definition of stress as a non-specific response of the body to any demand made upon it, this response--- in the Systems theory is made without regard to the nature of the problem. With this, stressors can be defined as either positive or negative (Tomey & Alligood, 2004). Caplans Conceptual Model is a model adapted by Neuman in which she integrated the three different prevention levels. Primary prevention, as defined in her own theory, is reducing the possibility of an encounter with a stressor or strengthening the organism to decrease the reaction to the stressor if the interaction does occur (Tomey & Alligood, 2004). Pierre Tielhard deChardin & Karl Marx who is of French descent, is a Jesuit priest and philosopher. He theorized that human beings are continually evolving to an Omega Point or rather a state of perfection. In this theory, developed by deChardin in The Future of Man (1950) states that a higher form of existence does exist; this higher

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Neumans Systems Model form of existence includes higher level of material complexity and consciousness. To deChardin, the search and movement towards an Omega point is something which must occur and cannot be undone. Neuman mainly uses the philosophy derived from deChardin on the wholeness of life, and integrates this into her definition of the wholistic client approach. Marxist philosophy the properties or attributes of parts are determined in part by larger wholes within dynamically organized systems (Callinicos, 2010). With this adopted philosophy, Neuman was able to confirm in her theory that the patterns created by the whole also influence the awareness of a single part (Tomey & Alligood, 2004). Basic Assumptions (Neuman, 1995) 1. Nursing clients are dynamic; they have both unique and universal characteristics

and are in constant energy exchange with environment, both internal and external 2. The relationship between client variables (physiological, psychological, sociocultural, developmental, and spiritual) influences a clients prospective mechanisms and determines a clients response. 3. Clients present normal range of responses to the environment that represent wellness and stability. 4. Stressors attack the flexible line of defense, then normal lines of defense 5. Nurses actions are focused on primary, secondary, and tertiary prevention. Major Concepts, and Definitions 1. Person/Client the person, family, group, or community, are the client or client system. When discussing a system with more than one member, the relationships between members must be clearly defined to establish boundries on who is

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Neumans Systems Model included in the system (Meleis, 2011).The Client is a dynamic composite of interrelationships or five interacting variables of physiological, psychological, sociocultural, developmental, and spiritual factors.

2. Environment Identified as the internal and external factors in which the client is both affected and can affect (McQuiston & Webb, 2008). The relationship between the person and the environment is reciprocal. Stressors are an important concept of the environment and are described as the forces which have the potential to alter a systems stability (Neuman & Fawcett, 2011). 3. Health Health, in Neumans model, is a continuum of wellness. A state of health is considered to be a state of stability, in that the needs of all the systems are being met (Neuman, 1995). The client is in a state of either wellness or illness at any given point of time (Tomey & Alligood, 2004) 4. Nursing This has been defined by Neuman as A unique profession in that it is concerned with all of the variables affecting an individuals response to stress (Tomey & Alligood, 2004). The focal point of nursing is to keep a clients system stable, through the use of accurate assessment of the various stressors and their possible effects (Sitzman & Eichelberger, 2011). 5. Wholistic Client Approach This is a view where the client is see as an open , dynamic, system, and the focus of nursing intervention is to identify problems or possible problems which may evolve from a thorough understanding of a clients unique environmental stressors (Tomey & Alligood, 2004). The system model considers all of the systems, and how their variables relate and affect one another, in physical, psychological, social, and spiritual faces (Neuman, 1995). The term

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Neumans Systems Model holistic was changed to wholistic to avoid confusion and to enhance the understanding that the term referred to a person in his or her entirety (Tomey & Alligood, 2004).

6. Open System Elements are in constant exchange within a complex organization. Stress and reaction to stress are major elements to an open system (Meleis, 2011). 7. Created environment Unconscious mobilization of all system variables towards system integration, stability, and integrity (McQuiston & Webb, 2008). 8. Content All variables of man in interaction with the environment comprise the whole system of the client (Neuman & Fawcett, 2011). Physiological -Body structure or function Psychological Mental processes, functioning, and emotions Sociocultural refers to relationships, cultural functions, and activities Spiritual refers to the influence of spiritual beliefs Developmental refers to the developmental processes in life.

9. Stressors Produce either a positive or negative effect on the system, and are described to potentially affect the stability of the client system: Interpersonal Between individuals Extapersonal outside an individual Intrapersonal within an individual

10. Basic or Core Structure The basic survival factors or energy resources of the client. These are common in all organisms, and include: Normal temperature range the ability to maintain homeostasis in regard to temperature.

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Neumans Systems Model Genetic Structure Bodily features Response pattern homeostatic functioning of body systems Organ Strength or weakness the ability of particular organs to endure stress. Ego Structure the I or personal essence. Knowns or commonalities value system

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11. Input and Output Matter, energy, or information exchanged between systems 12. Feedback Matter, energy, or information for future input for a corrective action to change, enhance, or stabilize a system (Tomey & Alligood, 2004). 13. Negentrophy Energy utilization towards wellness (Sitzman & Eichelberger). 14. Entrophy Energy depletion, leading towards illness or death (Sitzman & Eichelberger). 15. Stability Ability to cope with stressors and meet the demands of the various interrelated systems. It is functional harmony or balance; the maintenance of the integrity of the whole system (Meleis, 2011). 16. Wellness When parts of a client system interact in harmony 17. Illness disharmony between client systems as a result of unmet needs in varied degrees. 18. Flexible lines of defense In the conceptual model, this is the outer most circle, symbolized by a dotted line to emphasize the elasticity of the line of defense in a persons system. A flexible line of defense is what keeps a system free of stressors or allows the ability to cope with stressors without the core of the system being affected negatively. The flexible line of defense is dependent upon variables

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Neumans Systems Model such as sleep, the quality or quality of stressors, and the nutritional status of the

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person. If it is penetrated, the normal line of defense follows. The relationship of the five content or variables can affect the quantity in which individuals can defend against stressors. 19. Normal Line of Defense This is the concentric circle which represents the usual wellness level, or how an organism has changed over time in response to coping. This represents the overall stability state of an individual, maintained over time, which is why it is represented by a solid circle. The normal line of defense is dependent upon the clients abilities and his or her environment. It also includes the clients attributes such as: intelligence, attitudes, problem solving abilities, and coping abilities. An example of the normal line of defense is callous formation in response to integumentary stress. 20. Lines of Resistance Protects the core of a system or client, the core which is represented by the survival needs all organisms have in common. The line of resistance is activated when the stressor penetrates the normal line of defense. One such example given by Neuman of this line in action is the increase of the white blood cell count in response to infection or a foreign body. 21. Degree of reaction The amount of energy needed to fully respond to a stressor. 22. Prevention as Intervention Intervention are purposeful actions to help the client retain, attain, or maintain system stability. a. Primary Carried out when a stressor is suspected or identified. This does not mean that a problem exists, however, a factor in the client system can indicate the presence of possible future factors. As such, the nurse

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intervenes in a manner to reduce, if not totally avoid, the negative effect of the stressor. b. Secondary This is given after symptoms of stress occur. The point of nursing intervention at this rate is to reduce the reaction of the stress upon the client system and to use the internal and external resources of the client to strengthen the clients resistance and stabilization. c. Tertiary Occurs after active treatment and focuses on readjustment towards optimal client stability. A primary goal with this level of prevention is to strengthen the client system to prevent the reoccurrence of the stressful event. Tertiary prevention leads back to primary prevention in a circular fashion, as learned responses from the event may help the client avoid the stressorand therefore the effect of the stressin the future. 23. Reconstitution this occurs if resistance is successful or effective. It may occur in any portion of the system (Tomey & Alligood, 2011). Reconstitution either strengthens a line of defense for the system or it returns the system to a normal level of functioning (Nicoll, 2008). Betty Neumans Systems Model Stressors G Stressors A F E how C an individual, as wells as interacting with and responding to the environment and environmental stressors. It also represents B individual, including the correlations of complex systems of D Betty Neuman Systems Model represents the whole of the

systems interact simultaneously, just as stressors may occur at the same

time or during any given point of time. A person is an open system, always changing and

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evolving, to a state of perfection or an omega point, and in order to achieve this, a client system must maintain stability. Strengths of the Theory There are many strong points to the Neumans theory which allows for its flexibility in nursing as well as other health related disciplines. One such strength is that it was founded on sound theoretical basis and philosophies, instead of the use of theories formulated from nursing research that have yet to be proven. Although in 1972, the version utilizing the model had only weak empirical evidence, as it was collected only from students of her Masteral class, further publicized researches using the model strengthened the models effectiveness. Adding to this, a total of 100 studies between 1989 and 1993 were said to have used the framework as a guiding basis for research (Tomey & Alligood, 2004). Another characteristic of the theory adding to its strength are the clarity of the concepts (Nicoll, 2008). Although they are abstract, they are still concepts in which nurses are very familiar with. The concepts are complex, sometimes overlapping, and broad in spectrum, however they are presented and explained in a logical manner and can easily be used in any clinical setting (Tomey & Alligood, 2004). The model today continues to guide nurses in terms of gathering assessment data and the implementation of preventive intervention (Meleis, 2011).

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References 1. Callincios, A. (2010). The revolutionary ideas of karl marx. London: Bloomsbury. Checkland, P. (1997). Systems thinking, systems practice. Chichester: John Wiley & Sons, Ltd. McQuiston, C., & Webb, A. (2008). Foundations of nursing theory: contributions of 12 key theorists. (Vol. 13). University of Michigan: Sage Publications. Meleis, A. (2011). Theoretical nursing: development and progress. (5 ed.). New York: Lippincott Williams & Wilkins. Nicoll, L. (2008). Perspectives on nursing theory. University of Michigan: Lippincott. Neuman, B. (1995). The neuman systems model. (3 ed). University of Michigan: Appleton & Lange. Neuman, B., & Fawcett, J. (2011). The neuman systems model. (5 ed). New York: Pearson. Sitzman, K., & Eichelberger, L. (2011). Understanding the work of nurse theorists: a creative beginning. (2 ed.). New York: Jones & Bartlett Publishers. Tomey, A., & Alligood, M. (2004). Nursing theorists and their work. (3 ed.). Singapore: Elsevier (Singapore) PTE Ltd. http://nursingtheories.blogspot.com/2008/07/betty-neumans.html http://neumansystemsmodel.org/NSMdocs/neuman_systems_model_truste es.htm#Betty M. Neuman, R.N., B.S.N. http://www.neumann.edu/academics/undergrad/nursing/archives.asp

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