IDENTIFICATION DATA

 Name of the student teacher : Mr. Nikhil Dilip Ketkar

 Course : First Year M.Sc. Nursing
 Subject : Advance Nursing Practice
 Unit : VI
 Topic : Betty Neumans Theory
 Date :14/12/2022
 Venue : I yr MSC Nursing
 Time :
 Number of students :14
 Method of teaching : Lecture cum discussion
 A.V. Aids : Black board, power point, Leaflet,
pamplate.
 Previous knowledge of students : A group having less knowledge
regarding Betty Neumans Theory.
 GENERAL OBJECTIVES

After completion of this lesson plan students will be able to learn about Betty Neuman’s Theory
in-detailed.

SPECIFIC OBJECTIVES

After completion of this lesson plan students will be able to;

1. Introduce the Betty Neuman’s Theory
2. Desribe History & Background of Betty Neuman’s Theory
3. Enlist Development of Model.
4. Explain Basic Assumptions of Betty Neuman’s Theory
5. Describe Concept of Betty Neuman’s Theory.
6. Discuss Prevention of Theory.
7. Explain Nursing Paradigm.
8. Describe Stages Nursing Process
 BETTY NEUMAN'S THEORY

INTRODUCTION
 Betty Neuman’s system model provides a comprehensive flexible holistic and system
based perspective for nursing.
 It focuses on the response of the client system to actual or potential environmental
stressors and 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 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 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.

 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.

DEVELOPMENT OF THE MODEL

  Neuman’s model was influenced by a variety of sources.
 The philosophy writers deChardin and cornu (on wholeness in system).

 Von Bertalanfy, and Lazlo on general system theory.

 Selye on stress theory.

 Lararus on stress and coping.

BASIC ASSUMPTIONS

 Each client system is unique, a composite of factors and characteristics within a given
range of responses contained within a basic structure.
 Many known, unknown, and universal stressors exist. Each differ in it’s potential for
disturbing a client’s usual stability level or normal LOD

 The particular inter-relationships of client variables at any point in time can affect the
degree to which a client is protected by the flexible LOD against possible reaction to
stressors.

 Each client/ client system has evolved a normal range of responses to the environment
that is referred to as a normal LOD. The normal LOD can be used as a standard from
which to measure health deviation.

 When the flexible LOD is no longer capable of protecting the client/ client system against
an environmental stressor, the stressor breaks through the normal LOD

 The client whether in a state of wellness or illness, is a dynamic composite of the inter-
relationships of the variables. Wellness is on a continuum of available energy to support
the system in an optimal state of system stability.

 Implicit within each client system are internal resistance factors known as LOR, which
function to stabilize and realign the client to the usual wellness state.

 Primary prevention relates to G.K. that is applied in client assessment and intervention, in
identification and reduction of possible or actual risk factors.
  Secondary prevention relates to symptomatology following a reaction to stressor,
appropriate ranking of intervention priorities and treatment to reduce their noxious
effects.

 Tertiary prevention relates to adjustive processes taking place as reconstitution begins

and maintenance factors move the back in circular manner toward primary prevention.

 The client as a system is in dynamic, constant energy exchange with the environment.

MAJOR CONCEPTS

Content -

 the variables of the person in interaction with the internal and external environment
comprise the whole client system

Basic structure/Central core

 common client survival factors in unique individual characteristics representing basic

system energy resources.
 The basis structure, or central core, is made up of the basic survival factors that are
common to the species (Neuman,2002).

 These factors include:- - Normal temp. range, Genetic structure.- Response pattern.
Organ strength or weakness, Ego structure

 Stability, or homeostasis, occurs when the amount of energy that is available exceeds that
being used by the system.

 A homeostatic body system is constantly in a dynamic process of input, output, feedback,

and compensation, which leads to a state of balance.

Degree to reaction

 the amount of system instability resulting from stressor invasion of the normal LOD.
Entropy

 a process of energy depletion and disorganization moving the system toward illness or
possible death.

Flexible LOD

 a protective, accordion like mechanism that surrounds and protects the normal LOD from
invasion by stressors.

Normal LOD

 It represents what the client has become over time, or the usual state of wellness. It is
considered dynamic because it can expand or contract over time.

Line of Resistance-LOR

 The series of concentric circles that surrounds the basic structure.

 Protection factors activated when stressors have penetrated the normal LOD, causing a
reaction symptomatology. E.g. mobilization of WBC and activation of immune system
mechanism

Input- output

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

Negentropy

 A process of energy conservation that increase organization and complexity, moving the
system toward stability or a higher degree of wellness.

Open system
  A 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

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

Reconstitution

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

Stability

 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

 environmental factors, intra (emotion, feeling), inter (role expectation), and extra
personal (job or finance pressure) in nature, that have potential for disrupting system
stability.
 A stressor is any phenomenon that might penetrate both the F and N LOD, resulting
either a positive or negative outcome.

Wellness/Illness

 Wellness is the condition in which all system parts and subparts are in harmony with the
whole system of the client.
 o Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman,
2002).

o 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

 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
 On the other hand manipulates the environment to reduce or weaken stressors.

 Primary prevention includes health promotion and maintenance of wellness.

SECONDARY PREVENTION

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

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

FOUR NURSING PARADIGMS

PERSON

 human being is a total person as a client system and the person is a layered
multidimensional being.
 Each layer consists of five person variable or subsystems:

o Physiological- Refer of the physicochemical structure and function of the body.

o Psychological- Refers to mental processes and emotions.

o Socio-cultural- Refers to relationships; and social/cultural expectations and

activities.

o Spiritual- Refers to the influence of spiritual beliefs.

o Developmental- Refers to those processes related to development over the

lifespan.

ENVIRONMENT

 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.
 These forces include the intrapersonal, interpersonal and extra-personal stressors which
can affect the person’s normal line of defense and so can affect the stability of the
system.

o The internal environment exists within the client system.

o The external environment exists outside the client system.

 o Neuman also identified a created environment which is an environment that is
created and developed unconsciously by the client and is symbolic of system
wholeness.

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 (Neuman, 1995)”.
 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

 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.

 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.’’

 Neuman states that, because the nurse’s perception will influence the care given, then not
only must the patient/client’s perception be assessed, but so must those of the caregiver
(nurse).

 The role of the nurse is seen in terms of degree of reaction to stressors, and the use of
primary, secondary and tertiary interventions

STAGES OF NURSING PROCESS (BY NEUMAN)

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 and
constraints through synthesis of theory and data base.

 Broad hypothetical interventions are determined, i.e. maintain flexible line of defense.

NURSING GOALS

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

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.

Neuman’S SYSTEM MODEL FORMAT

Neuman’s nursing process format designates the following categories of data about the client
system as the major areas of assessment.

ASSESSMENT

 Potential and actual stressors.

 Condition and strength of basic structure factors and energy sources.

 Characteristics of flexible and normal line of defenses, lines of resistance, degree of

reaction and potential for reconstitution.

 Interaction between client and environment.

  Life process and coping factors (past, present and future) actual and potential stressors
(internal and external) for optimal wellness external.

 Perceptual difference between care giver and the client.

NURSING DIAGNOSIS

 The data collected are then interpreted to condition and formulate the Nursing diagnosis.
 Health seeking behaviors.

 Activity intolerance.

 Ineffective coping.

 Ineffective thermoregulation.

GOAL

 In Neuman’s systems model the goal is to keep the client system stable.

PLANNING

 Planning is focused on strengthening the lines of defense and resistance.

IMPLEMENTATION

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

ACCEPTANCE BY THE NURSING COMMUNITY

 Neuman’s model has been described as a grand nursing theory by walker and Avant.
 Grand theories can provide a comprehensive perspective for nursing practice, education,
and research and Neuman’s model does.

PRACTICE

 The Neuman systems model has been applied and adapted to various specialties include
family therapy, public health, rehabilitation, and hospital nursing.
 The sub specialties include pulmonary, renal, critical care, and hospital medical units.
One of the model’s strengths is that it can be used in a variety of settings

 Using this conceptual model permits comparison of a nurse’s interpretation of a problem

with that of the patient, so the patient and nurse do not work on two separate problems.

 The role of the nurse in the model is to work with the patient to move him as far as
possible along a continuum toward wellness.

 Because this model requires individual interaction with the total health care system, it is
indicative of the futuristic direction the nursing profession is taking.

 The patient is being relabeled as a consumer with individual needs and wants.

EDUCATION

 The model has also been widely accepted in academic circles.

 curriculum guide for a conceptual framework at Indiana University, Northwestern State
University in Shreveport, Louisiana.

RESEARCH
  A study was published by Riehl and Roy to test the usefulness of the Neuman model in
nursing practice.
 Acceptance by the nursing community for research applying this model is in the
beginning stages and positive.

NEUMAN'S SYSTEM MODEL AND THE CHARACTERISTICS OF A THEORY

 Neuman's model connects the interrelated concepts in such a way as to create a different
way of looking at a particular phenomenon.
 Neuman’s model in general presents itself as logically consistent.

 There is a logical sequence in the process of nursing wherein emphasis on the importance
of accurate data assessment is basic to the sequential steps of the nursing process.

 Neuman’s model is fairly simple and straightforward in approach.

 The terms used are easily identifiable and for the most part have definitions that are
broadly accepted.

 Neuman’s model, due to its high level and breadth of abstraction, lends itself to theory
development.

 The model has provided clear, comprehensive guidelines for nursing education and
practice in a variety of settings; this is its primary contribution to nursing knowledge.

 Neuman's model is applicable in the practice as assessment/intervention instrument

together with comprehensive guidelines for its use with the nursing process.

Research Articles

 “Using the Neuman Systems Model for Best Practices’’--Sharon A. DeWan, Pearl N.
Ume-Nwagbo, Nursing Science Quarterly, Vol. 19, No. 1, 31-35 (2006).
o The purpose of this study was to present two case studies based upon Neuman
systems model; one case is directed toward family care, and the other
 demonstrates care with an individual. Theory-based exemplars serve as teaching
tools for students and practicing nurses.

o These case studies illustrate how nurses' actions, directed by Neuman's wholistic
principles, integrate evidence-based practice and generate high quality care

 Melton L, Secrest J, Chien A, Andersen B. “A community needs assessment for a

SANE program using Neuman's model” J Am Acad Nurse Pract. 2001 Apr;13(4):178-
86.

o The purpose of the study was to present guidelines for a community needs
assessment for a Sexual Assault Nurse Examiner (SANE) program using
Neuman's Systems Model.

o Sexual assault is a problem faced by almost every community. A thorough

community assessment is an important first step in establishing programs that
adequately meet a community's needs.

o Guidelines for conducting such an assessment related to implementation of a

SANE program are rare, and guidelines using a nursing model were not found in
the literature.

SUMMARY

In this Seminar we have discussed, regarding Introduction, History & Background ,

Development of Model, Assumptions, Concept , Prevention, Nursing Paradigm & Stages of
Nursing Process.

REFERENCES

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4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed.
Philadelphia, Lippincott.

5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
Philadelphia, Lippincott.

6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process &
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