Exploration of Neumans System Model applied to Nursing
Nursing is a field in which critical thinking is required, however in order to do so, there are thought processes that allow for such things to occur. With the assistance of nursing theories and models, nurses are more able to guide their practices with a framework in mind, allowing for not only the adequate care of their clients, but sound clinical decision making. The model created by Betty Neuman, Neuman System Model, provides a simple, yet in-depth perspective for nursing using a holistic approach. The concept of stressors and their effects on ones system as a whole is the focus, as well as nursing preventative measures and interventions that allow for wellness of the system. Although, many use the terms theory and model interchangeably, these concepts have their own meanings. As the name Neuman's System Model suggests, Neuman developed a model as opposed to a theory. A theory is defined by George (1985) as a set of interrelated concepts that allow for a different view on a particular phenomenon. For that reason, Neuman's framework is considered a model simply because it represents the relationship between concepts rather than allowing for a new way of looking at a phenomenon. Throughout this discussion of Newman's System Model, a description and discussion of the origins of the model will take place, followed by an examination of nursing metaparadigm and the key concepts of the theory. Finally, a comparison of the model with my personal values and beliefs in nursing will be incorporated.
Understanding Origins of the Model
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The way one may view the world or person as a whole may change with time or various life experiences. Usually, there are lessons learned that allow for development or growth, as well as an increase in knowledge, through these experiences. In the case of nursing theories, this is no different. There are many reasons theories are formulated and in order to begin understanding a theory, it is important to understand the historical evolution of the theory.
Neuman's System Model, which was originally developed in 1970 as a method to teach one of her classes, was ultimately created to provide an overview of the physiological, psychological, socio-cultural, and developmental aspect of humans (Heyman, 2000). The basis of Neuman's model stemmed from a variety of sources that influenced the model itself. Selye's stress adaptation and interaction with environment influenced the ideas of Neuman a great deal and assisted with providing the basis for some of Neuman's work (George, 1985). Chardin and Cornu's ideas that emphasizing the importance of parts of a system being seen as a whole rather than as individualized sections working independently, influenced the development of this model (Neuman, 1989). Alongside Chardin and Cornu, General Adaptation Theory discusses stress and the body's responses, and this also aided the development of this theory. The idea that there are three stages the body will go through in order to maintain homeostasis during a time where there is stress being placed on the body is another important aid to this models development (Heyman, 2000). In addition to these contributing theories, General Systems theory influenced Neuman's System Models' development by its assumptions "that energy is needed to maintain a high organizational state and that a dysfunction in one system will affect other systems, particularly if the dysfunctional system is a subsystem of a larger system" (Heyman, 2000, para. 4). Today, this model is a well-known and widely used model not only in the field of nursing, but in others as well and as discussed, there are many sources that motivated Neuman's development of the System's Model and influenced the creation of this framework.
Regardless of the origins of this model, there are philosophical values and beliefs of the theorist that remain quite prominent in the consideration of a nursing theory. Each theorist has their own views that shape the development of their theory. The main philosophical beliefs/values that can be extracted from Neuman include, "holism, a wellness orientation, client perception and motivation, with a systems perspective of variable interaction with the environment." (Fitzpatrick & Whall, 2005, p.195). She also believes that the nurse and the client together, can allow for the client to retain, restore and maintain an optimal level of health through the prevention of exposure to stressors (Neuman, 1989). With this in mind, more emphasis is placed on the nurse assisting the client to reach a state of wellness, although, ultimately, through dealing with responses to stressors and assisting the client to respond better to stressors, the client's wellness would be a priority. Therefore, as discussed, these are the primary philosophical beliefs/values that Neuman holds.
As each theory usually views the nursing metaparadigm differently, the concepts according to Neuman's will be discussed in the following section. The nursing metaparadigm concepts consist of the person, environment, health and nursing.
According to Neuman, the person is viewed as an "open system" and a "total person" (Neuman, 1989). This means that rather than viewing the person as comprised of various parts and each part functioning individually, the person is consisted of parts; however, they function as a whole (view appendix 1). The many dimensions of a person, as described by Neuman, are said to include physiological, psychological, sociocultural, developmental and spiritual variables (Heyman, 2000). In Neuman's model, the concepts of lines of defence and resistance comprise the person and both of these are affected by the various stressors that may be present. Because the normal line of defence represents the 'normal' level of wellness in a person, when stressors of everyday life are placed on an individual, the ability to adjust to it will be displayed through this line of defence (Fitzpatrick & Whall, 2005). The flexible line of defence acts as a protective barrier for the normal line of defence and being used when stressors are present in the clients system (Fitzpatrick & Whall, 2005). In contrary, the line of resistance would be responsible for creating a balance in the system and stabilizing the person after a reaction to a stressor (Fitzpatrick & Whall, 2005). The terminology 'person' is considered to include the individual, the family, group and even the community, therefore, 'the person' can refer to a large population not only consisting of one being according to Neuman's model. The idea that the person is seen as always being in constant change with its environment is another key idea according to Neuman, as the person is affecting and being affected by the environment (Heyman, 2000).
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The next element of nursing metaparadigm is environment. The environment to Neuman, consists of the internal, external, and created environment (Neuman, 1989). These environments include stressors that can be intrapersonal, interpersonal, or extrapersonal; each of these affects the environment and its stability. The internal environment is comprised of forces that create and effect the defined client system, while with the external environment would include both inter- and extrapersonal stressors that are external to the client system (Neuman, 1989). The created environment "acts as an intrapersonal protective shield against the reality of the environment... the true nature or reality of client and environmental changes" (Neuman, 1989, p.130). To Neuman, this type of environment is created and develops unconsciously around the client, and can be said to symbolize system wholeness (Heyman, 2000).
Health, to Neuman, is seen as the "degree of client wellness that exists at any point in time, ranging from an optimal wellness condition, with available energy at its maximum, to death, which represents total energy depletion" (Neuman, 1989, p.129). Thus, according to Neuman, the levels of energy within the clients system will determine whether one is 'well'. So, it can be concluded that wellness would be associated with energy levels that are high, rather than low levels hence, the client would not be in a state of wellness. When looking at the lines of defence and health, there is a relationship that exists. Since the normal line of defence displays the usual level of wellness, when there is stressors placed on a system, due to unmet needs, the wellness level decreases (Neuman, 1989). If "a client's degree of wellness is determined by how effectively client system variables react to environmental stressors" (Fitzpatrick & Whall, 2005, p.201), the normal line of defence would be able to accommodate change in the system, similar to the flexible line of defence (Fitzpatrick & Whall, 2005). Ultimately, in Neuman's model, the internal external and created environmental forces would be related to this concept of health.
Neuman describes nursing as a "unique profession" that focuses on the person as a whole, and the variables that affect the response to stressors. According to Neuman, retaining and attaining stability in the client system to reduce stressors is the most important goal of nursing (Neuman, 1989). Heyman (2000) points out how Neuman made it clear that, because care provided will be influenced by the nurse's perceptions, nurses must assess their own perceptions in addition to assessing the clients. Primary, secondary, and tertiary preventions are the nursing interventions that are emphasized in this model and allow for flexible lines of defence and resistance to stressors to be strengthened and adaptation, promoted (Andrist, L., Nicholas, P., Wolf, K.A., & Wolf, K., 2006). Depending on the type of intervention that would be used, the nurse's role would change. For example, if a client's system has not reacted to a stressor (primary prevention), then the nurse would focus interventions on maintaining the healthy state and health promotion (Fitzpatrick & Whall, 2005). However, if system had reacted to the stressor (secondary prevention), then the nurse would focus on removing the stressor and protecting and preventing damage to the system as well as strengthening the lines of resistance (Fitzpatrick & Whall, 2005). In the case that the client was experiencing symptoms (tertiary prevention), clearly the stressors have impacted the system greatly and nursing interventions would focus on limiting the effects of the stressor on the system, as well as reducing the amount of energy needed to limit the use of energy and preserve the amount available in the system (Fitzpatrick & Whall, 2005).
Neuman recreated the nursing process with three steps consisting of nursing diagnosis, nursing goals and nursing outcomes. The nursing diagnosis phase includes a nursing assessment of all factors affecting the client followed by the implementation of the appropriate nursing interventions once a problem has been identified (Fitzpatrick &Whall, 2005). Nurse-client collaboration in negotiating goals occurs subsequently, the effectiveness of the interventions would be evident in the outcomes and evaluation would then occur (Neuman, 1989). Thus, the concept of nursing is included in the Neuman System Model.
Therefore, it is evident that Neuman's model not only encompasses the four concepts of a nursing metaparadigm, (person, environment, health, and nursing) but looking at the metaparadigm, is effective in aiding a better understanding of the System Model.
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It is important to understand the main concepts within a model, to allow for greater comprehension of the model, so that it can be applied to ones practice.
Neuman views the central core as the basic factor that each person contains which will allow for survival (Heyman, 2000). Examples of these include the ability to regulate body temperature, physical strength, cognition, system that functions through homeostasis and value systems (Heyman, 2000). Neuman believes that the central core is in constant change; therefore, stability and homeostasis are imperative to maintaining the important balance of energy in the system. Stressors are another very vital concept within Neuman's model. Stressors are anything that disrupts equilibrium within the system of the client (types were discusses earlier, see section titled Environment) (George, 1985).With the disruption of this equilibrium, energy would also be imbalanced so consequently, the concept of lines of defence and lines of resistance would come into account. As discussed earlier, there is a flexible line of defence and a normal line of defence. The role of the flexible line of defence is to "protect" the normal line of defence. In the case that the flexible line of defence is unable to perform its duty, the line of resistance would then become involved due to the normal line of defence becoming invaded by the stressors that the flexible line of defence was initially shielding it from (Heyman, 2000). The ability of the system to adapt to changes in energy, specifically the increase in energy due to the reaction to a stressor in the system, is referred to as reconstitution (Fitzpatrick & Whall, 2005).
For example, in the case of a client going to hospital with flu like symptoms the stressor would be the virus that has passed the flexible line of defence and also the normal line of defence. Because of the effect of the stressors on the normal line of defence the body is losing energy, a larger amount is being used than is available and equilibrium is thrown off. When this occurs, the body launches an immune response, another energy requiring process that places an additional demand on energy needed. In Neuman's model, the immune response would be the line of resistance attempting to bring the body back to its original state of equilibrium through fighting the virus. Eventually, with time, the system will produce more energy and reconstitution will occur.
Another concept, prevention, is divided up into three types, primary, secondary and tertiary (as discussed earlier in the Nursing section), is seen as the primary nursing intervention and prevents stressors from harming the body (Heyman, 2000). As discussed, the many concepts in the Neuman System Model, relate to one another, and allow for greater understanding of this framework.
Personal Nursing Practice
Nurses are one of the most respected jobs in our society today and healthcare without nurses would be chaotic. To me nurses are the advocators for clients and the backbone of the healthcare team. As a student, I have had many opportunities to interact with nurses in the hospitals through my clinical experiences. The characteristics of nursing that I see in my weekly clinical interactions that have shaped the way I view nurses are numerous. I feel that the most important characteristics I can identify in nurses and hopefully will be able to identify in myself in the future include: being knowledgeable, having great strength and being reliable and accountable are very important characteristics to possess as a nurse. The caring persona and trustworthiness are also other things I see as important in nursing. Like I mentioned earlier, these are characteristics I have noticed in my experiences with nurses in clinical, and I too one day in the near future, hope to possess them as well.
When it comes to values that I possess, I am a strong believer that you cannot help someone that does not try to help themselves. What I mean by this is that regardless of the amount of effort and care a nurse puts into her care for a client, the client must contribute in order for progress to be made or change to occur. Through learning about Neuman's beliefs, I found that there is a parallel in our thoughts on this topic. Neuman believes that "caregivers and clients work in partnership to achieve optimal health" (Neuman, 2001, p.12 in Fitzpatrick & Whall, 2005). So, Neuman also believes that the client must be involved in their care so that a state of health can be reached. The idea the health is not just comprised of the physical aspects of human beings but also mentally is a belief of mine, I also believe that spirituality can affect one's health due to religion being an important value to me. After learning about Neuman's factors that affect 'the person' I realized that we shared the idea that health is not simply comprised of two aspects of one person, but it is many aspects of the person that influence ones health, spirituality being one of the factors. This also shows that she looks at the person as a whole and not just as individual parts, which is the concept of holism, a very key concept within her model. Additionally, it is my belief that nursing is a practice that is client focused and should always have the client's best interest at heart. When comparing this to Neuman, the clients best interest is the also the priority. We know this because of the main nursing goal is to prevent stress on the client so that they can maintain equilibrium and be 'healthy'. Neuman & Reed (2007) state that"the model is designed to organize and direct care-giving activities with the client as central focus." (Neuman & Reed, 2007, p.112). Evidently, my belief that the client's best interest is vital in nursing, is similar to that of Neuman's idea the client is the focus of care. Nursing, to me, is a field in which, health promotion and promoting good health behaviours is very beneficial to the prevention of illness in the future. Again, this is similar to Neuman's model in that, the primary nursing intervention consists of prevention and along-side prevention, is health promotion which would occur for example, in the case of a primary intervention.
So, through looking at my own personal views, values, and beliefs on nursing, I have realized that many of the views Neuman has are similar to the ones I have, and that her model is one that I can picture myself using as a framework to guide my practice.
In conclusion, Neuman's System model is a model that views the person as a whole system that is constantly trying to maintain a state of wellness. Throughout the course of this exploration of Neuman's model, a description and discussion of the origins of the model took place, an examination of the nursing metaparadigm and its concepts, as well as the key concepts of the theory were discussed and lastly the personal nursing practice was incorporated. Through increasing understanding of Neuman's work, it was found that this model is a useful framework for nursing but can be applied to other fields as well; it was not only understandable but applicable to the everyday clinical situations nurses are involved in.
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