Neuman Systems Model

1. Neuman Systems Model Roline Campbell Roxy Johanning Tracy Hill

2. Presentation Objectives: Introduce Betty Neuman Overview of the Neuman Systems Model (NSM) it’s concepts and principles Evaluate the NSM nursing theory using Fawcett’s criteria Compare the NSM with two other nursing theories Discuss and analyze the use of the NSM

3. Meet Betty Neuman • Born in 1924 on a farm near Lowell, Ohio. • Completed initial nursing education • Then moved to Los Angeles • Worked in a variety of nursing roles - always with an interest in human behavior. • She attended UCLA • 1957: Completed bachelor’s degree with a double major in Public Health & Psychology. • Helped her husband to establish and manage his medical practice.

4. Career advances 1966: Master’s degree in Mental Health, Public Health Consultation from UCLA. Pioneer of nursing involvement in mental health. Late 1960’s: Teaching and practice model for mental health consultation. Requests from UCLA graduate students prompted the design of a conceptual model for nursing in 1970. First published in 1972 in an article entitled “A Model for Teaching Total Person Approach to Patient Problems” (Neuman & Young, 1972). 1974 – 2002: Further development and refinement of the NSM. (First called “The Neuman Systems Model” in 1985 – retained the same title since then.) 1985: Doctoral degree in Clinical Psychology from PWU.

5. Recent years Maintained involvement in variety of professional and international activities Moved back to Watertown, Ohio and practiced as a licensed clinical marriage and family therapist. Founder/Director of the Neuman Systems Model Trustees Group, Inc. Holds two Honorary Doctorates 1992: Honorary Doctorate of Letters (Neuman College) 1998: Honorary Doctorate of Science (Grand Valley State University) Fellow of the American Academy of Nursing (1993)

6. “It is important to state that neither was I knowledgeable about nursing models nor had a clear trend yet begun in nursing for developing models. The Neuman Systems Model was developed strictly as a teaching aid”- Betty Neuman, 2002 Betty Neuman as keynote speaker at the University of Maine, Fort Kent in 2004.

7. An Overview of the Neuman Systems Model

8. Philosophical Claims Wholism Wellness orientation Client perception and motivation Dynamic systems perspective of energy & variable interaction with the environment Client & caregiver in partnership

9. Key Concepts Classified according to the applicable metaparadigm forerunner.

10. Client/Client System • Viewed as open system • Repeated cycles of input, process, output & feedback • Thus a dynamic organizational pattern • Can be • Individual • Family • Group • Community • Aggregate (Social Issue)

11. Interacting Variables Consider these simultaneously & comprehensively Present in each type of client

12. Central Core

13. Flexible Line of Defense (FLD) • Outer barrier (protective buffer) • Dynamic – can be altered in relatively short period of time • Prevents stressor invasion of the client system

14. Normal Line of Defense (NLD) • Client’s normal wellness level • What client has become / evolved into over time • Defines the stability & integrity of client system • Standard from which to measure health deviation

15. Lines of Resistance • Protective mechanism • Attempts to stabilize the client system (support return to wellness) • Supports the basic structure & normal line of defense • Contains resource factors

16. Internal Environment Forces & interactive influences confined within client system Intrapersonal Stressors

17. External Environment Forces & interaction influences existing outside the client system Interpersonal stressors Extra-personal stressors

18. Created Environment Symbolic expression of system wholeness Unconscious mobilization of all system variables Extra-personal Intrapersonal Interpersonal

19. Wellness and Illness Optimal Wellness • System stability • Greatest possible degree of system stability at a given point in time Illness • State of insufficiency • Disrupting needs are unsatisfied • Excessive expenditure of energy • Variance from Wellness • Varying degrees of system instability • Difference from the normal or usual wellness condition.

20. Prevention as Intervention Basis for health promotion Nursing is prevention as intervention Three dimensions Primary prevention Secondary prevention Tertiary prevention

21. Primary Prevention Health promotion & Maintenance of wellness Occurs before the system reacts to a stressor Strengthens the client / client system to better deal with stressors (FLD) May also try to manipulate the environment to reduce or weaken stressors

22. Secondary Prevention Focus on preventing damage to the Central Core Occurs after the system reacts to a stressor Aims to strengthen the Lines of Resistance May also try to remove the stressor

23. Tertiary Prevention Occurs after the client/client system has been treated through secondary prevention strategies Offers support to the client Attempts to: add energy to the system or reduce energy needed in order to facilitate reconstitution

24. Reconstitution • The determined energy increase related to the degree of reaction to a stressor • Represents the return and maintenance of system stability following treatment • May be viewed as feedback from the input/output of secondary prevention • Complete reconstitution may occur • Level beyond the initial Normal Line of Defense • Same level of wellness prior to illness • Lower level where system stability is re-defined

25. Evaluation of the Neuman Systems Model Jacqueline Fawcett and Betty Neuman at the 8th Neuman Systems Model Symposium - Salt Lake City, 2001

26. Jacqueline Fawcett on Betty Neuman’s System Model Theory: • Neuman System Model Trustee since: 1988 • Areas of Consultation with the Neuman Systems Model: • Serve as a mentor and consultant for students, post-doctoral fellows, faculty, and clinicians interested in using nursing models and theories to guide their research and practice, including the Neuman Systems Model.

27. Selected Neuman Systems Model Publications • Fawcett, J., Carpenito, L. J., Efinger, J., Goldblum‑Graff, D., Groesbeck, M. J., Lowry, L. W., McCreary, C. S., & Wolf, Z. R. (1982). A framework for analysis and evaluation of conceptual models of nursing with an analysis and evaluation of the Neuman Systems Model. In B. Neuman (Ed.), The Neuman Systems Model. Application to nursing education and practice (pp. 30‑43). New York: Appleton‑Century‑Crofts. • Fawcett, J. (1989). Analysis and evaluation of Neuman's systems model. In B. Neuman (Ed.), The Neuman Systems Model. Application to nursing education and practice (2nd ed., pp. 65-92). Norwalk, CT: Appleton and Lange. • Fawcett, J. (1995). Constructing conceptual-theoretical-empirical structures for research: Future implications for use of the Neuman systems model. In B. Neuman, The Neuman Systems Model (3rd ed., pp. 459-471). Norwalk, CT: Appleton and Lange. • Beynon, C.E., Chadwick, P.L., Chang, N.J., Craig, D.M., Fawcett, J., Freese, B.T., Hinton-Walker, P., & Neuman, B. (1997). The Neuman systems model: Reflections and projections. Nursing Science Quarterly, 10, 18-21. • Fawcett, J. (2001). The nurse theorists: 21st century updates—Betty Neuman. Nursing Science Quarterly, 14, 211-214. • Fawcett, J., & Giangrande, S.K. (2001). Neuman Systems Model-based research: An integrative review project. Nursing Science Quarterly, 14, 231-238. •   Fawcett, J., & Gigliotti, E. (2001). Using conceptual models of nursing to guide nursing research: The case of the Neuman Systems Model. Nursing Science Quarterly, 14, 339-345.

28. Selected Neuman Systems Model Publications(cont.) • Neuman, B., Aylward, P.D., Beynon, C., Breckenridge, D.M., Fawcett, J., Fields, A., Lowry, L., Memmott, R.J., & Toot, J. (2001). The Neuman systems model: A futuristic care perspective. In N. L. Chaska (Ed.), The nursing profession: Tomorrow and beyond (pp. 321-330). Thousand Oaks, CA: Sage. • Neuman, B., & Fawcett, J. (Eds.). (2002). The Neuman systems model (4th ed.). Upper Saddle River, NJ: Prentice Hall. • Freese, B.T., Neuman, B., & Fawcett, J. (2002). Guidelines for Neuman systems model-based clinical practice. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed., pp. 37-42). Upper Saddle River, NJ: Prentice Hall. • Louis, M., Neuman, B., & Fawcett, J. (2002). Guidelines for Neuman systems model-based nursing research. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed., pp. 113-119). Upper Saddle River, NJ: Prentice Hall. • Fawcett, J., & Giangrande, S.K. (2002). The Neuman systems model and research: An integrative review. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed., pp. 120-149). Upper Saddle River, NJ: Prentice Hall. • Gigliotti, E., & Fawcett, J. (2002). The Neuman systems model and research instruments. In B. Neuman & J. Fawcett (Eds.). The Neuman systems model (4th ed., pp. 150-175). Upper Saddle River, NJ: Prentice Hall. • Newman, D.M.L., Neuman, B., & Fawcett, J. (2002). Guidelines for Neuman systems model-based education for the health professions. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed., pp. 193-215). Upper Saddle River, NJ: Prentice Hall. • Shambaugh, B.F., Neuman, B., & Fawcett, J. (2002). Guidelines for Neuman systems model-based administration of health care services. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed., pp. 265-270). Upper Saddle River, NJ: Prentice Hall.

29. Fawcett’s Criteria to Evaluate Nursing Theory • Significance • Internal Consistency • Parsimony • Testability • Empirical Adequacy • Pragmatic Adequacy

30. Significance - Meets • Metaparadigm concepts & propositions are explicitly stated • All philosophical claims are addressed • Support of colleagues and the influence of other scholars & adjunctive disciplines are acknowledged (Psychology & Philosophy) • Special contributions made by NSM to discipline of nursing are identified • Usefulness in Education, Research, Practice & Administration of Health Care Services

31. Internal Consistency - Meets • Neuman values a holistic (“wholistic”), systems-based approach to the care of clients. • Revisions and refinements indicates Neuman’s responsiveness to critiques. • The basic intent, meaning, and purpose of the model have been retained.

32. Parsimony - Meets • NSM is sufficiently comprehensive with regard to depth of content. • The revisions and refinements in Neuman’s (2002d) current version have clarified several areas of confusion found in earlier versions and have improved the adequacy of concept definitions and descriptions (Fawcett, 2005). • Confusion still remains in the Family, Community, and Social Issue dimensions of the Client/Client System – these dimensions require definitions or descriptions that go beyond being described as kinds of groups.

33. Testability - Meets • The guidelines for research based on NSM are clearly defined and are congruent with the theory (Optimal Client System Stability). • Research and practice are linked: Problems encountered in practice give rise to new research questions (Fawcett, 2005). • NSM based research continues to increase.

34. Empirical Adequacy – Partially met • The content of the NSM is not completely logically congruent. • Additional research is clearly warranted (Varying statistical significance). • Neuman considers her model to be appropriate for use by members of all health-care disciplines.

35. Pragmatic Adequacy - Meets • Extensive study of the concepts of the NSM and relevant theories from nursing and adjunctive disciplines is required before knowledgeable application in nursing research, education, administration, and practice. • The content of the NSM comprises many terms, but most are familiar words; therefore, use of the model does not require mastery of an extensive vocabulary. • The success of the NSM as a guide for nursing curricula and for delivery of nursing services is documented in several reports (Fawcett, 2005).

36. Comparison of NSM with two other nursing theories / models

38. Contemporaries of one another

39. Each Define the Metaparadigm Concepts: • Person • Environment • Health • Nursing

40. Each Used in Nursing: • Practice • Administration • Education

41. Theories derived from:

42. Goal of Nursing

43. Overview

44. Worldview

45. Reciprocal Interaction Worldview This worldview is a synthesis of elements from the organismic, simultaneity, totality, change, persistence and interactive-integrative world views: • Human beings are holistic; parts are viewed on the context of the whole • Human beings are active, and interactions between human beings and their environments are reciprocal • Change is a function of multiple antecedent factors, and may be continuous or may be only for survival • Reality is multidimensional, context dependent, and relative (Fawcett, 2005, p.12-13)

46. Simultaneous Action World View This world view combines elements of the organismic, simultaneity, change and unitary-transformative world views: • Unitary human beings are identified by pattern • Human beings are in mutual rhythmical interchange with their environments • Human beings change continuously, unpredictably and in the direction of more complex self-organization • The phenomena of interest are personal knowledge and pattern recognition (Fawcett, 2005, p. 13)

47. Meets Fawcett’s Criteria for Evaluation of Nursing Models • Rogers • Roy • Neuman (Fawcett 2005, p. 57-58)

48. Selection Rationale

49. Discussion of the Nurse as the Client • Galloway (1993) offered an informative NSM-based self-analysis of her practice with a mentally and physically impaired infant. She stated: • “Through analyzing my role as a student nurse in a difficult clinical situation, I learned that I not only adapted well but also experienced personal growth. I did not avoid the reality of my situation; rather, I worked within the difficulties it presented. Understanding the importance of identifying and expressing emotions, I did not deny my positive and negative feelings. By using effective coping mechanisms and introducing alternative methods as necessary to deal with stressors, I achieved a positive result. Although my flexible line of defense contracted slightly due to the influence of specific negative variables, it buffered effectively so that my underlying normal line of defense was not penetrated (p. 36).” (Fawcett, 2005, p. 206)

50. Discussion Points