BACHELOR OF SCIENCE IN NURSING NCMA 110 (Theoretical Foundations of Nursing)

COURSE MODULE COURSE UNIT WEEK 1 8 8

• Read course and unit objectives • Read study guide prior to class attendance • Read required learning resources; refer to unit terminologies for jargons • Proactively participate in classroom discussions • Participate in weekly discussion board (Canvas) • Answer and submit course unit tasks

1. Personal Laptop/mobile device 2. Internet connection/device 3. Reading materials 4. Paper and Pen for writing

1. At the end of the course unit (CM), learners will be able to:

Johnson, Roy and Neuman

2

Cognitive:

1. Define and explain Dorothy Johnson, Sister Callista Roy and Betty Neuman’s Theory

Affective:

1. Inculcate the importance of their contribution and models in our clinical practice. 2. Listen attentively during class discussions. 3. Demonstrate tact and respect when challenging other people’s opinions and ideas. 4. Accept comments and reactions of classmates on one’s opinions openly and graciously.

Psychomotor:

1. Apply the principles of Nursing theories during class discussion. 2. Participate actively during class discussions. 3. Confidently express personal opinion and thoughts in front of the class.

• BehavioralSystemModel-definedNursingas“anexternalregulatoryforcewhichactsto

preservetheorganizationandintegrationofthepatients’behaviorsatanoptimumlevelunderthoseconditionsinwhichthebehaviorconstitutesathreattothephysicalorsocialhealth,orinwhichillnessisfound.”

• AdaptationModel-Roydefinednursingasa“healthcareprofessionthatfocusesonhumanlifeprocessesandpatternsandemphasizespromotionofhealthforindividuals,families,groups,andsocietyasawhole.”

• Neuman’sSystemModel,nursingasa“uniqueprofessioninthatisconcernedwithallof

thevariablesaffectinganindividual’sresponsetostress.” •

Dorothy Johnson: Behavioral System Model

Biography of Dorothy E. Johnson DorothyE.Johnson(August21,1919–February1999)wasoneofthegreatestnursingtheoristswhodevelopedthe“BehavioralSystemModel.”Hertheoryofnursingdefinesnursingas“anexternalregulatoryforcewhichactstopreservetheorganizationandintegrationofthepatientsbehaviorsatanoptimumlevelunderthoseconditionsinwhichthebehaviorconstitutesathreattothephysicalorsocialhealth,orinwhichillnessisfound.”

Early Life DorothyJohnsonwasbornonAugust21,1919inSavannah,Georgia.Shewastheyoungestofsevenchildren.Herfatherwasthesuperintendentofashrimpandoysterfactoryandhermotherwasveryinvolvedandenjoyedreading.In1938,shefinishedherassociatesdegreeinArmstrongJuniorCollegeinSavannah,Georgia.DuetotheGreatDepression,shetookayearofffromschooltobeagoverness,orteacher,fortwochildreninMiami,Florida.Thisiswhenshebegantorealizedherloveforchildren,nursingandeducation.

Education

Vanderbilt University School of Nursing Class of 1942 with Dorothy Johnson on the back row second from left. DorothyJohnson’sprofessionalnursingcareerbeganin1942whenshegraduatedfromVanderbiltUniversitySchoolofNursingininNashville,Tennessee.ShewasthetopstudentinherclassandreceivedtheprestigiousVanderbiltFounder’sMedal.

In1948,shereceivedherMastersinpublichealthfromHarvardUniversityinBoston,Massachusetts.

Career and Appointments Aftergraduation,DorothyJohnson’sprofessionalexperiencesinvolvedmostlyteaching,althoughshewasastaffnurseattheChatham-SavannahHealthCouncilfrom1943to1944.ShewasaninstructorandanassistantprofessorinpediatricnursingatVanderbiltUniversitySchoolofNursing.From1949untilherretirementin1978andhersubsequentmovetoKeyLargo,Florida,Johnsonwasanassistantprofessorofpediatricnursing,anassociateprofessorofnursing,andaprofessorofnursingattheUniversityofCalifornia,LosAngeles.

In1955and1956,JohnsonwasapediatricnursingadvisorassignedtotheChristianMedicalCollegeSchoolofNursinginVellore,SouthIndia.From1965to1967,sheservedaschairpersononthecommitteeoftheCaliforniaNursesAssociationthatdevelopedapositionstatementonspecificationsfortheclinicalspecialist.

Behavioral System Model DorothyJohnsonisknownforher“BehavioralSystemModelofNursing,”whichwasfirstproposedin1968.Hernursingmodelstatesthat“eachindividualhaspatterned,purposeful,repetitivewaysofactingthatcomprisesabehavioralsystemspecifictothatindividual.”

Itadvocatesthefosteringofefficientandeffectivebehavioralfunctioninginthepatienttopreventillness.Thepatientisdefinedasabehavioralsystemcomposedofsevenbehavioralsubsystems:affiliative,dependency,ingestive,eliminative,sexual,aggressive,andachievement.

Eachsubsystemalsohasthreefunctionalrequirementswhichinclude(1)protectionfromnoxiousinfluences,(2)provisionforanurturingenvironment,and(3)stimulationforgrowth.Animbalanceineachsystemresultsindisequilibrium.Thenurse’sroleistohelpthepatientmaintainhisorherequilibrium.

BehavioralSystemModelofNursingisfurtherdiscussedbelow.

Works DorothyJohnsonwasaprolificwriteronthesubjectofnursingtheory.Hermanypublicationsonthissubjectprofoundlyinfluencedtheoreticalthinkinginnursingduringthesecondhalfofthetwentiethcentury.Johnson’spublicationsincludefourbooks,morethan30articlesinperiodicals,andmanypapers,reports,proceedings,andmonographs.

Sheheldastrongconvictionthatcontinuingimprovementofcarewastheultimategoalofnursing.Her1968paper,entitled,OneConceptualModelofNursing,isaclassiccontributiontoNursingliterature.

TwoofthemanyworkswrittenbyJohnsoninclude:TheoryDevelopment:What,Why,How?andBarriersandHazardsinCounseling.

Awards and Honors Ofthemanyhonorsshereceived,DorothyJohnsonwasproudestofthe1975FacultyAwardfromgraduatestudents,the1977LuluHassenplugDistinguishedAchievementAwardfromtheCaliforniaNursesAssociation,andthe1981VanderbiltUniversitySchoolofNursingAwardforExcellenceinNursing.

Death DorothyJohnsondiedinFebruary1999attheageof80.Beforeshedied,shewaspleasedthathertheoryhadbeenfoundusefulinfurtheringthedevelopmentofatheoreticalbasisfornursingandwasbeingusedasamodelfornursingpracticeonaninstitution-widebasis,butshereportedthathergreatestsourceofsatisfactioncamefromfollowingtheproductivecareersofherstudents.

Johnson’s Behavioral System Model DorothyE.Johnsoniswell-knownforher“BehavioralSystemModel,”whichwasfirstproposedin1968.HermodelwasgreatlyinfluencedbyFlorenceNightingale’sbook,NotesonNursing.Itadvocatesthefosteringofefficientandeffectivebehavioralfunctioninginthepatienttopreventillnessandstressestheimportanceofresearch-basedknowledgeabouttheeffectofnursingcareonpatients.

Johnson’sBehavioralSystemModelisamodelofnursingcarethatadvocatesthefosteringofefficientandeffectivebehavioralfunctioninginthepatienttopreventillness.Thepatientisidentifiedasabehavioralsystemcomposedofsevenbehavioralsubsystems:affiliative,dependency,ingestive,eliminative,sexual,aggressive,andachievement.Thethreefunctionalrequirementsforeachsubsystemincludeprotectionfromnoxiousinfluences,provisionforanurturingenvironment,andstimulationforgrowth.Animbalanceinanyofthebehavioralsubsystemsresultsindisequilibrium.Itisnursing’sroletoassisttheclienttoreturntoastateofequilibrium.

What is Behavioral System Model? DorothyJohnson’stheorydefinedNursingas“anexternalregulatoryforcewhichactstopreservetheorganizationandintegrationofthepatient’sbehaviorsatanoptimumlevelunderthoseconditionsinwhichthebehaviorconstitutesathreattothephysicalorsocialhealth,orinwhichillnessisfound.”

Italsostatesthat“eachindividualhaspatterned,purposeful,repetitivewaysofactingthatcomprisesabehavioralsystemspecifictothatindividual.”

Goals DorothyJohnsonbeganherworkonthemodelwiththepremisethatnursingwasaprofessionthatmadeadistinctivecontributiontothewelfareofsociety.Thus,nursinghadanexplicitgoalofactioninpatientwelfare.

Thegoalsofnursingarefourfold,accordingtotheBehaviorSystemModel:(1)Toassistthepatientwhosebehaviorisproportionaltosocialdemands.(2)Toassistthepatientwhoisabletomodifyhisbehaviorinwaysthatitsupportsbiologicalimperatives.(3)Toassistthepatientwhoisabletobenefittothefullestextentduringillnessfromthephysician’sknowledgeandskill.And(4)Toassistthepatientwhosebehaviordoesnotgiveevidenceofunnecessarytraumaasaconsequenceofillness.

Assumptions of the Behavioral System Model TheassumptionsmadebyDorothyJohnson’stheoryareinthreecategories:assumptionsaboutsystem,assumptionsaboutstructure,andassumptionsaboutfunctions.

Johnsonidentifiedseveralassumptionsthatarecriticaltounderstandingthenatureandoperationofthepersonasabehavioralsystem:(1)Thereis“organization,interaction,interdependencyandintegrationofthepartsandelementsofbehaviorsthatgotomakeupthesystem.”(2)Asystem“tendstoachieveabalanceamongthevariousforcesoperatingwithinanduponit,andthatmanstrivecontinuallytomaintainabehavioralsystembalanceandsteadystatebymoreorlessautomaticadjustmentsandadaptationstothenaturalforcesoccurringonhim.”(3)Abehavioralsystem,whichrequiresandresultsinsomedegreeofregularityandconstancyinbehavior,isessentialtoman.Itisfunctionallysignificantbecauseitservesausefulpurposeinsociallifeaswellasfortheindividual.And(4)“Systembalancereflectsadjustmentsandadaptationsthataresuccessfulinsomewayandtosomedegree.”

Thefourassumptionsaboutstructureandfunctionarethat:(1)“Fromtheformthebehaviortakesandtheconsequencesitachievescanbeinferredwhat‘drive’hasbeenstimulatedorwhat‘goal’isbeingsought.”(2)Eachindividualpersonhasa“predispositiontoactwithreferencetothegoal,incertainwaysratherthantheotherways.”Thispredispositioniscalleda“set.”(3)Eachsubsystemhasarepertoireofchoicescalleda“scopeofaction.”And(4)Theindividualpatient’sbehaviorproducesanoutcomethatcanbeobserved.

Andlastly,therearethreefunctionalrequirementsforthesubsystems.:(1)Thesystemmustbeprotectedfromtoxicinfluenceswithwhichthesystemcannotcope.(2)Eachsystemhastobenurturedthroughtheinputofappropriatesuppliesfromtheenvironment.And(3)Thesystemmustbestimulatedforusetoenhancegrowthandpreventstagnation.

Major Concepts ThefollowingarethemajorconceptsanddefinitionsoftheJohnson’snursingmodelincludingthedefinitionforitsnursingmetaparadigm:

Human Beings

Johnsonviewshumanbeingsashavingtwomajorsystems:thebiologicalsystemandthebehavioralsystem.Itistheroleofmedicinetofocusonthebiologicalsystem,whereasnursing’sfocusisthebehavioralsystem.

Theconceptofhumanbeingwasdefinedasabehavioralsystemthatstrivestomakecontinualadjustmentstoachieve,maintain,orregainbalancetothesteady-statethatisadaptation.

Environment

Environmentisnotdirectlydefined,butitisimpliedtoincludeallelementsofthesurroundingsofthehumansystemandincludesinteriorstressors.

Health

Healthisseenastheoppositeofillness,andJohnsondefinesitas“somedegreeofregularityandconstancyinbehavior,thebehavioralsystemreflectsadjustmentsandadaptationsthataresuccessfulinsomewayandtosomedegree…adaptationisfunctionallyefficientandeffective.”

Nursing

Nursingisseenas“anexternalregulatoryforcewhichactstopreservetheorganizationandintegrationofthepatient’sbehavioratanoptimallevelunderthoseconditionsinwhichthebehaviorconstitutesathreattophysicalorsocialhealth,orinwhichillnessisfound.”

Behavioral system

Manisasystemthatindicatesthestateofthesystemthroughbehaviors.

System

Thatwhichfunctionsasawholebyvirtueoforganizedindependentinteractionofitsparts.

Subsystem

Aminisystemmaintainedinrelationshiptotheentiresystemwhenitortheenvironmentisnotdisturbed.

Subconcepts

Structure Thepartsofthesystemthatmakeupthewhole.

Variables

Factorsoutsidethesystemthatinfluencethesystem’sbehavior,butwhichthesystemlackspowertochange.

Boundaries

Thepointthatdifferentiatestheinteriorofthesystemfromtheexterior.

Homeostasis

Processofmaintainingstability.

Stability

Balanceorsteady-stateinmaintainingbalanceofbehaviorwithinanacceptablerange.

Stressor

Astimulusfromtheinternalorexternalworldthatresultsinstressorinstability.

Tension

Thesystem’sadjustmenttodemands,changeorgrowth,ortoactualdisruptions.

Instability

Stateinwhichthesystemoutputofenergydepletestheenergyneededtomaintainstability.

Set

Thepredispositiontoact.Itimpliesthatdespitehavingonlyafewalternativesfromwhichtoselectabehavioralresponse,theindividualwillrankthoseoptionsandchoosetheoptionconsideredmostdesirable.

Function

Consequencesorpurposesofaction.

7 Subsystems of the Behavior System Model JohnsonidentifiessevensubsystemsintheBehavioralSystemModel.Theyare:

Johnson’s Behavioral System Model

Attachment or affiliative subsystem

Attachmentoraffiliativesubsystemisthe“socialinclusionintimacyandtheformationandattachmentofastrongsocialbond.”Itisprobablythemostcriticalbecauseitformsthebasisforallsocialorganization.Onagenerallevel,itprovidessurvivalandsecurity.Itsconsequencesaresocialinclusion,intimacy,andtheformationandmaintenanceofastrongsocialbond

Dependency subsystem

Dependencysubsystemisthe“approval,attentionorrecognitionandphysicalassistance.”Inthebroadestsense,itpromoteshelpingbehaviorthatcallsforanurturingresponse.Itsconsequencesareapproval,attentionorrecognition,andphysicalassistance.Developmentally,dependencybehaviorevolvesfromalmosttotaldependenceonotherstoagreaterdegreeofdependenceonself.Acertainamountofinterdependenceisessentialforthesurvivalofsocialgroups.

Ingestive subsystem

Ingestivesubsystemisthe“emphasisonthemeaningandstructuresofthesocialeventssurroundingtheoccasionwhenthefoodiseaten.”Itshouldnotbeseenastheinputandoutputmechanismsofthesystem.Allsubsystemsaredistinctsubsystemswiththeirowninputandoutputmechanisms.Theingestivesubsystem“hastodowithwhen,how,what,howmuch,andunderwhatconditionsweeat.”

Eliminative subsystem

Eliminativesubsystemstatesthat“humancultureshavedefineddifferentsociallyacceptablebehaviorsforexcretionofwaste,buttheexistenceofsuchapatternremainsdifferentfromculturetoculture.”Itaddresses“when,how,andunderwhatconditionsweeliminate.”Aswiththeingestivesubsystem,thesocialandpsychologicalfactorsareviewedasinfluencingthebiologicalaspectsofthissubsystemandmaybe,attimes,inconflictwiththeeliminativesubsystem.

Sexual subsystem

Sexualsubsystemisbothabiologicalandsocialfactorthataffectsbehavior.Ithasthedualfunctionsofprocreationandgratification.Including,butnotlimitedto,courtingandmating,thisresponsesystembeginswiththedevelopmentofgenderroleidentityandincludesthebroadrangeofsex-rolebehaviors.

Aggressive subsystem

Aggressivesubsystemrelatestothebehaviorsconcerningprotectionandself-preservation,generatingadefenseresponsewhenthereisathreattolifeorterritory.Itsfunctionisprotection

andpreservation.Societydemandsthatlimitsbeplacedonmodesofself-protectionandthatpeopleandtheirpropertyberespectedandprotected.

Achievement subsystem

Achievementsubsystemprovokesbehaviorthattriestocontroltheenvironment.Itattemptstomanipulatetheenvironment.Itsfunctioniscontrolormasteryofanaspectofselforenvironmenttosomestandardofexcellence.Areasofachievementbehaviorincludeintellectual,physical,creative,mechanical,andsocialskills.

Behavioral System Model and The Nursing Process ThenursingprocessoftheBehaviorSystemModelofNursingbeginswithanassessmentanddiagnosisofthepatient.Onceadiagnosisismade,thenurseandotherhealthcareprofessionalsdevelopanursingcareplanofinterventionsandsettingtheminmotion.Theprocessendswithanevaluation,whichisbasedonthebalanceofthesubsystems.

Johnson’sBehavioralSystemModelisbestappliedintheevaluationphase,duringwhichtimethenursecandeterminewhetherornotthereisbalanceinthesubsystemsofthepatient.Ifanursehelpsapatientmaintainanequilibriumofthebehavioralsystemthroughanillnessinthebiologicalsystem,heorshehasbeensuccessfulintherole.

Strengths DorothyJohnson’stheoryguidesnursingpractice,education,andresearch;generatesnewideasaboutnursing;anddifferentiatesnursingfromotherhealthprofessions.

Ithasbeenusedininpatient,outpatient,andcommunitysettingsaswellasinnursingadministration.Ithasalwaysbeenusefultonursingeducationandhasbeenusedinpracticeineducationalinstitutionsindifferentpartsoftheworld.

AnotheradvantageofthetheoryisthatJohnsonprovidedaframeofreferencefornursesconcernedwithspecificclientbehaviors.Itcanalsobegeneralizedacrossthelifespanandacrosscultures.

Weaknesses Thetheoryispotentiallycomplexbecausethereareanumberofpossibleinterrelationshipsamongthebehavioralsystem,itssubsystems,andtheenvironment.Potentialrelationshipshavebeenexplored,butmoreempiricalworkisneeded.

Johnson’sworkhasbeenusedextensivelywithpeoplewhoareillorfacethethreatofillness.However,itsusewithfamilies,groups,andcommunitiesislimited.

ThoughthesevensubsystemsidentifiedbyJohnsonaresaidtobeopen,linked,andinterrelated,thereisalackofcleardefinitionsfortheinterrelationshipsamongthemwhichmakesitdifficulttoviewtheentirebehavioralsystemasanentity.

TheprobleminvolvingtheinterrelationshipsamongtheconceptsalsocreatesdifficultyinfollowingthelogicofJohnson’swork.

Conclusion Johnson’sBehavioralSystemModeldescribesthepersonasabehavioralsystemwithsevensubsystems:theachievement,attachment-affiliative,aggressiveprotective,dependency,ingestive,eliminative,andsexualsubsystems.Eachsubsystemisinterrelatedwiththeothersandtheenvironmentandspecificstructuralelementsandfunctionsthathelpmaintaintheintegrityofthebehavioralsystem.

Throughthese,thefocusofhermodeliswithwhatthebehaviorthepersonispresentingmakingtheconceptmoreattunedwiththepsychologicalaspectofcarein.

Whenthebehavioralsystemhasbalanceandstability,theindividual’sbehaviorswillbepurposeful,organized,andpredictable.Imbalanceandinstabilityinthebehavioralsystemoccurwhentensionandstressorsaffecttherelationshipofthesubsystemsortheinternalandexternalenvironments.

Sister Callista Roy: Adaptation Model of Nursing

Biography of Callista Roy SisterCallistaL.Roy(bornOctober14,1939)isanursingtheorist,profession,andauthor.SheisknownforhergroundbreakingworkincreatingtheAdaptationModelofNursing.

Education and Career CallistaRoyreceivedherBachelorofArtsMajorinNursingfromMountSaintMary’sCollegeinLosAngelesin1963andhermaster’sdegreeinnursingfromtheUniversityofCaliforniain1966.

Afterearninghernursingdegrees,Roybeganhereducationinsociology,receivingbothamaster’sdegreeinsociologyin1973andadoctoratedegreeinsociologyin1977fromtheUniversityofCalifornia.

Duringhertimeinworkingtowardhermaster’sdegree,RoywaschallengedinaseminarwithDorothyE.Johnsontodevelopaconceptualmodelfornursing.Royworkedasapediatricnurseandnoticedagreatresiliencyofchildrenandtheirabilitytoadaptinresponsetomajorphysicalandpsychologicalchanges.Impressedbythisadaptation,Royworkedtowardsanappropriateconceptualframeworkfornursing.

ShedevelopedthebasicconceptsofthemodelwhileshewasagraduatestudentattheUniversityofCaliforniafrom1964to1966.

In1968,shebeganoperationalizinghermodelwhenMountSaintMary’sCollegeadoptedtheadaptationframeworkasthephilosophicalfoundationofthenursingcurriculum.

RoywasanassociateprofessorandchairpersonoftheDepartmentofNursingatMountSaintMary’sCollegeuntil1982andwaspromotedtotherankofprofessorin1983atbothMountSaintMary’sCollegeandtheUniversityofPortland.Shehelpedinitiateandtaughtinasummermaster’sprogramattheUniversityofPortland.

ShewasaRobertWoodJohnsonpostdoctoralfellowattheUniversityofCalifornia,SanFranciscofrom1983to1985asaclinicalnursescholarinneuroscience.Itwasduringthistimesheconductedresearchonnursinginterventionsforcognitiverecoveryinheadinjuriesandontheinfluenceofnursingmodelsonclinicaldecisionmaking.

In1987topresent,RoybeganthenewlycreatedpositionofresidentnursetheoristatBostonCollegeSchoolofNursingwheresheteachesdoctoral,master’s,andundergraduatestudents.

In1991,shefoundedtheBostonBasedAdaptationResearchinNursingSociety(BBARNS),whichwouldlaterberenamedtheRoyAdaptationAssociation.

Roy’sotherscholarlyworkincludesconceptualizingandmeasuringcopinganddevelopingthephilosophicalbasisfortheadaptationmodelandfortheepistemologyofnursing.

RoybelongstotheSistersofSt.JosephofCarondelet.

Adaptation Model of Nursing Sr.CallistaRoy’sAdaptationModelofNursingwasdevelopedbySisterCallistaRoyin1976.Theprominentnursingtheoryaimstoexplainordefinetheprovisionofnursing.Inhertheory,Roy’smodelseestheindividualasasetofinterrelatedsystemswhostrivestomaintainbalancebetweenthesevariousstimuli.AdaptationModelofNursingisdiscussedfurtherbelow.

Works Sr.CallistaRoyhasnumerouspublications,includingbooksandjournalarticles,onnursingtheoryandotherprofessionaltopics.Herworkshavebeentranslatedintomanylanguageallovertheworld.

RoyandhercolleaguesatRoyAdaptationAssociation,hascritiquedandsynthesizedthefirst350researchprojectspublishedinEnglishbasedonheradaptationmodel.

HermostfamousworkisontheRoyadaptationmodelofnursing.

Callista Roy’s Adaptation Model of Nursing TheAdaptationModelofNursingisaprominentnursingtheoryaimingtoexplainordefinetheprovisionofnursingscience.Inhertheory,SisterCallistaRoy’smodelseestheindividualasasetofinterrelatedsystemswhostrivestomaintainabalancebetweenvariousstimuli.

TheRoyAdaptationModelwasfirstpresentedintheliteratureinanarticlepublishedinNursingOutlookin1970entitled“Adaptation:AConceptualFrameworkforNursing.”Inthesameyear,Roy’sAdaptationModelofNursingwasadaptedinMountSt.Mary’sSchoolinLosAngeles,California.

Roy’smodelwasconceivedwhennursingtheoristDorothyJohnsonchallengedherstudentsduringaseminartodevelopconceptualmodelsofnursing.Johnson’snursingmodelwastheimpetusforthedevelopmentofRoy’sAdaptationModel.

Roy’smodelincorporatedconceptsfromAdaptation-levelTheoryofPerceptionfromrenownAmericanphysiologicalpsychologistHarryHelson,LudwigvonBertalanffy’sSystemModel,andAnatolRapoport’ssystemdefinition.

First,considertheconceptofasystemasappliedtoanindividual.Royconceptualizesthepersoninaholisticperspective.Individualaspectsofpartsacttogethertoformaunifiedbeing.Additionally,aslivingsystems,personsareinconstantinteractionwiththeirenvironments.Betweenthesystemandtheenvironmentoccursanexchangeofinformation,matter,andenergy.Characteristicsofasystemincludeinputs,outputs,controls,andfeedback.

Assumptions

Scientific Assumptions

• Systems of matter and energy progress to higher levels of complex self-organization.

• Consciousness and meaning are constructive of person and environment integration.

• Awareness of self and environment is rooted in thinking and feeling.

• Humans by their decisions are accountable for the integration of creative processes.

• Thinking and feeling mediate human action.

• System relationships include acceptance, protection, and fostering of interdependence.

• Persons and the earth have common patterns and integral relationships.

• Persons and environment transformations are created in human consciousness.

• Integration of human and environment meanings results in adaptation.

Philosophical Assumptions

• Persons have mutual relationships with the world and God.

• Human meaning is rooted in the omega point convergence of the universe.

• God is intimately revealed in the diversity of creation and is the common destiny of creation.

• Persons use human creative abilities of awareness, enlightenment, and faith.

• Persons are accountable for the processes of deriving, sustaining, and transforming the universe.

Major Concepts of the Adaptation Model ThefollowingarethemajorconceptsofCallistaRoy’sAdaptationModelincludingthedefinitionofthenursingmetaparadigmasdefinedbythetheory.

Person

“Humansystemshavethinkingandfeelingcapacities,rootedinconsciousnessandmeaning,bywhichtheyadjusteffectivelytochangesintheenvironmentand,inturn,affecttheenvironment.”

BasedonRoy,humansareholisticbeingsthatareinconstantinteractionwiththeirenvironment.Humansuseasystemofadaptation,bothinnateandacquired,torespondtotheenvironmentalstimulitheyexperience.Humansystemscanbeindividualsorgroups,suchasfamilies,organizations,andthewholeglobalcommunity.

Environment

“Theconditions,circumstancesandinfluencessurroundingandaffectingthedevelopmentandbehaviorofpersonsorgroups,withparticularconsiderationofthemutualityofpersonandhealth

resourcesthatincludesfocal,contextualandresidualstimuli.”

Theenvironmentisdefinedasconditions,circumstances,andinfluencesthataffectthedevelopmentandbehaviorofhumansasanadaptivesystem.Theenvironmentisastimulusorinputthatrequiresapersontoadapt.Thesestimulicanbepositiveornegative.

Roycategorizedthesestimuliasfocal,contextual,andresidual.Focalstimuliarethatwhichconfrontsthehumansystemandrequiresthemostattention.Contextualstimuliarecharacterizedastherestofthestimulithatpresentwiththefocalstimuliandcontributetoitseffect.Residualstimuliaretheadditionalenvironmentalfactorspresentwithinthesituation,butwhoseeffectisunclear.Thiscanincludepreviousexperiencewithcertainstimuli.

Health

“Healthisnotfreedomfromtheinevitabilityofdeath,disease,unhappiness,andstress,buttheabilitytocopewiththeminacompetentway.”

Healthisdefinedasthestatewherehumanscancontinuallyadapttostimuli.Becauseillnessisapartoflife,healthistheresultofaprocesswherehealthandillnesscancoexist.Ifahumancancontinuetoadaptholistically,theywillbeabletomaintainhealthtoreachcompletenessandunity

withinthemselves.Iftheycannotadaptaccordingly,theintegrityofthepersoncanbeaffectednegatively.

Nursing

“[Thegoalofnursingis]thepromotionofadaptationforindividualsandgroupsineachofthefouradaptivemodes,thuscontributingtohealth,qualityoflife,anddyingwithdignity.”

InAdaptationModel,nursesarefacilitatorsofadaptation.Theyassessthepatient’sbehaviorsforadaptation,promotepositiveadaptationbyenhancingenvironmentinteractionsandhelpingpatientsreactpositivelytostimuli.Nurseseliminateineffectivecopingmechanismsandeventuallyleadtobetteroutcomes.

Adaptation

Adaptationisthe“processandoutcomewherebythinkingandfeelingpersonsasindividualsoringroupsuseconsciousawarenessandchoicetocreatehumanandenvironmentalintegration.”

Internal Processes

Regulator Theregulatorsubsystemisaperson’sphysiologicalcopingmechanism.It’sthebody’sattempttoadaptviaregulationofourbodilyprocesses,includingneurochemical,andendocrinesystems.

Cognator

Thecognatorsubsystemisaperson’smentalcopingmechanism.Apersonuseshisbraintocopeviaself-concept,interdependence,androlefunctionadaptivemodes.

Four Adaptive Modes

Diagrammatic Representation of Roy’s Human Adaptive Systems. Click to enlarge. Thefouradaptivemodesofthesubsystemarehowtheregulatorandcognatormechanismsaremanifested;inotherwords,theyaretheexternalexpressionsoftheaboveandinternalprocesses.

Physiological-Physical Mode

Physicalandchemicalprocessesinvolvedinthefunctionandactivitiesoflivingorganisms.Thesearetheactualprocessesputinmotionbytheregulatorsubsystem.

Thebasicneedofthismodeiscomposedoftheneedsassociatedwithoxygenation,nutrition,elimination,activityandrest,andprotection.Thecomplexprocessesofthismodeareassociatedwiththesenses,fluidandelectrolytes,neurologicfunction,andendocrinefunction.

Self-Concept Group Identity Mode

Inthismode,thegoalofcopingistohaveasenseofunity,meaningthepurposefulnessintheuniverse,aswellasasenseofidentityintegrity.Thisincludesbodyimageandself-ideals.

Role Function Mode

Thismodefocusesontheprimary,secondaryandtertiaryrolesthatapersonoccupiesinsociety,andknowingwhereheorshestandsasamemberofsociety.

Interdependence Mode

Thismodefocusesonattainingrelationalintegritythroughthegivingandreceivingoflove,respectandvalue.Thisisachievedwitheffectivecommunicationandrelations.

Levels of Adaptation

Integrated Process Thevariousmodesandsubsystemsmeettheneedsoftheenvironment.Theseareusuallystableprocesses(e.g.,breathing,spiritualrealization,successfulrelationship).

Compensatory Process

Thecognatorandregulatorarechallengedbytheneedsoftheenvironment,butareworkingtomeettheneeds(e.g.,grief,startingwithanewjob,compensatorybreathing).

Compromised Process

Themodesandsubsystemsarenotadequatelymeetingtheenvironmentalchallenge(e.g.,hypoxia,unresolvedloss,abusiverelationships).

Six-Step Nursing Process Anurse’sroleintheAdaptationModelistomanipulatestimulibyremoving,decreasing,increasingoralteringstimulisothatthepatient

1. Assessthebehaviorsmanifestedfromthefouradaptivemodes.

2. Assessthestimuli,categorizethemasfocal,contextual,orresidual.

3. Makeastatementornursingdiagnosisoftheperson’sadaptivestate.

4. Setagoaltopromoteadaptation.

5. Implementinterventionsaimedatmanagingthestimuli.

6. Evaluatewhethertheadaptivegoalhasbeenmet.

Analysis Asoneoftheweaknessesofthetheorythatapplicationofitistime-consuming,applicationofthemodeltoemergencysituationsrequiringquickactionisdifficulttocomplete.Theindividualmighthavecompletedthewholeadaptationprocesswithoutthebenefitofhavingacompleteassessmentforthoroughnursinginterventions.

Adaptiveresponsesmayvaryineveryindividualandmaytakealongertimecomparedtoothers.Thus,thespanofcontrolofnursesmaybeimpededbythetimeofthedischargeofthepatient.

UnlikeLevine,althoughthelattertackledonadaptation,Roygavemuchfocusonthewholeadaptivesystemitself.Eachconceptwaslinkedwiththecopingmechanismsofeveryindividualintheprocessofadapting.

Thenurses’roleswhenanindividualpresentsanineffectiveresponseduringhisorheradaptationprocesswerenotclearlydiscussed.Themainpointoftheconceptwastopromoteadaptationbutnonewerestatedonhowtopreventandresolvemaladaptation.

Strengths of the Roy’s Adaptation Model • TheAdaptationModelofCallistaRoysuggeststheinfluenceofmultiplecausesina

situation,whichisastrengthwhendealingwithmulti-facetedhumanbeings.

• ThesequenceofconceptsinRoy’smodelfollowslogically.Inthepresentationofeachofthekeyconcepts,thereistherecurringideaofadaptationtomaintainintegrity.Everyconceptwasoperationallydefined.

• TheconceptsofRoy’smodelarestatedinrelativelysimpleterms.

• Amajorstrengthofthemodelisthatitguidesnursestouseobservationandinterviewingskillsindoinganindividualizedassessmentofeachperson.TheconceptsofRoy’smodelareapplicablewithinmanypracticesettingsofnursing.

Weaknesses • Painstakingapplicationofthemodelrequiressignificantinputoftimeandeffort.

• Roy’smodelhasmanyelements,systems,structuresandmultipleconcepts.

Betty Neuman: Neuman Systems Model BettyNeuman(1924–present)isanursingtheoristwhodevelopedtheNeumanSystemsModel.Shegavemanyyearsperfectingasystemsmodelthatviewsatpatientsholistically.SheinquiredtheoriesfromseveraltheoristsandphilosophersandappliedherknowledgeinclinicalandteachingexpertisetocomeupwiththeNeumanSystemsModelthathasbeenaccepted,adopted,andappliedasacorefornursingcurriculuminmanyareasaroundtheworld.

Biography of Betty Neuman

Early Life BettyNeumanwasbornin1924nearLowell,Ohio.Shegrewuponafarmwhichlaterencouragedhertohelppeoplewhoareinneed.Herfatherwasafarmerwhobecamesickanddiedattheageof36.Hermotherwasaself-educatedmidwife,thatledtheyoungNeumantobealways

influencedbythecommitmentthattookherawayfromhomefromtimetotime.Shehadoneolderbrotherandabrotherwhowasyoungerwhichmakesherthemiddlechildamonghersiblings.Herlovefornursingstartedwhenshetooktheresponsibilityoftakingcareofherfatherwhichlatercreatedhercompassioninherchosencareerpath.

Education Asayounggirl,sheattendedthesameone-roomschoolhousethatherparentshadattendedandwasexcitedwhenshewenttoahighschoolthathadalibrary.Shewasalwaysengagedandfascinatedwiththestudyofhumanbehavior.DuringWorldWarII,shehadherfirstjobasanaircraftinstrumenttechnician.In1947,shereceivedherRNDiplomafromPeoplesHospitalSchoolofNursing,Akron,Ohio.

Nursing Career of Betty Neuman BettyNeumanmovedtoCaliforniaandworkedinavarietyofcapacitiesasahospitalnurseandheadnurseatLosAngelesCountyGeneralHospital,schoolnurse,industrialnurse,andclinicalinstructorattheUniversityofSouthernCaliforniaMedicalCenter,LosAngeles.

In1957,shereceivedabaccalaureatedegreeinpublichealthandpsychologywithhonors.Amidstherhecticlifeasanurse,shealsomanagedtoworkasafashionmodelandlearnedtoflyaplane.Shegotmarried,supportedherhusband’smedicalpractice,andhadtheirdaughterin1959.

Shealsoearnedamaster’sdegreeinmentalhealth,publichealthconsultationin1966fromtheUniversityofCalifornia,LosAngeles(UCLA).Afterhergraduation,shewashiredasadepartmentchairintheUCLASchoolofNursinggraduateprogram.NeumandevelopedthefirstcommunitymentalhealthprogramforgraduatestudentsintheLAareafrom1967to1973.

In1985,BettyNeumanconcludedadoctoraldegreeinclinicalpsychologyatPacificWesternUniversity.Shewasapioneerofnursinginvolvementinmentalhealth.SheandDonnaAquilinawerethefirsttwonursestodevelopthenursecounselorrolewithincommunitycrisiscentersinLosAngeles.

Neumanpersistedtostartaprivatepracticeasamarriageandfamilytherapist,specializinginChristiancounseling.SheisaFellowoftheAmericanAssociationofMarriageandFamilyTherapyandoftheAmericanAcademyofNursing.Until2009,shewasthedirectoroftheNeumanSystemsModelTrusteesGroup,Inc.thatsheestablishedin1988,andstillattendsasaconsultant.TheTrusteesGroupwascreatedtopreserveandmaintainthemessageofhernursingtheoryforthehealthcarecommunity.

Works of Betty Neuman In1970,BettyNeumandesignedanursingconceptualmodeltoexpandstudents’understandingofclientvariablesbeyondthemedicalmodel.HerteachingprogramsatUCLApavedthewayfordevelopinghernursingmodel.Duringthosetimes,shedidnotwriteabookbutmadeherconceptsknowntoJoanRiehl-SiscaandSr.CallistaRoyandincorporatedthemintheir1971book,ConceptualModelsforNursingPractice.

In1972,Neumanpublishedadraftofhermodel.Shedevelopedandimprovedtheconceptsandpublishedherbook,TheNeumanSystemModel:ApplicationtoNursingEducationandPractice,in1982.Furtherrevisionsweremadeinlatereditions.Asaspeakerandauthor,shespentcountlesshoursteachingandexplainingthemanyconceptsandaspectsofthemodeltostudentsandprofessors.

Neumanhasalsobeeninvolvedinnumerouspublications,paperpresentations,consultations,lectures,andconferencesonapplicationanduseofthemodel.Sheworkedasaconsultantnationallyandinternationallyconcerningtheimplementationofthemodelfornursingeducationprogramsandforclinicalpracticefacilities.

Awards and Honors of Betty Neuman BettyNeumanhasdonemanythingsincludinganurse,educator,healthcounselor,therapist,author,speaker,andresearcher.Throughouttheyears,sheearnedmanyawardsandhonorsincludingseveralhonorarydoctoratesandwasanhonorarymemberoftheAmericanAcademyofNursing.Theprofoundeffectofherworkonthenursingprofessioniswellknownthroughouttheworld.

• HonoraryDoctorateofLetters,NeumannCollege,Aston,PA(1992)

• HonoraryMemberoftheFellowshipoftheAmericanAcademyofNursing(1993)

• HonoraryDoctorateofScience,GrandValleyStateUniversity,Michigan(1998)ShewashonoredbyPresidentRichardJusseaumeandProvostDr.LaurenceBovewiththeWalshUniversityDistinguishedServiceMedal,whichisawardedtothosewhohavecontributedoutstandingprofessionalorvoluntaryservicetootherswithinthenational,regionalorlocalcommunity.

InanannualNursingResearchDaysponsoredbyWalsh’sPhiEtaChapterofSigmaThetaTau,ByersSchoolofNursingDeanDr.LindaLincgrantedNeumanwiththefirstannualNeumanAward,namedinherhonor,foroutstandingserviceinthenursingprofession.

Betty Neuman’s Nursing Theory Threewordsfrequentlyusedinrelationtostressareinevitable,painfulandintensifying.Itisgenerallysubjective,andcanbeinterpretedasthecircumstancesoneregardsasconceivablythreateningandoutoftheircontrol.AnursingtheorydevelopedbyBettyNeumanisbasedontheperson’srelationshiptostress,theresponsetoit,andreconstitutionfactorsthatareprogressiveinnature.TheNeumanSystemsModelpresentsabroad,holisticandsystem-basedmethodtonursingthatmaintainsafactorofflexibility.Itfocusesontheresponseofthepatientsystemtoactualorpotentialenvironmentalstressorsandthemaintenanceoftheclientsystem’sstabilitythroughprimary,secondary,andtertiarynursingpreventioninterventiontoreducestressors.

What is the Neuman Systems Model? BettyNeumandescribestheNeumanSystemsModelas“aunique,open-system-basedperspectivethatprovidesaunifyingfocusforapproachingawiderangeofconcerns.Asystemactsasaboundaryforasingleclient,agroup,orevenanumberofgroups;itcanalsobedefinedasasocialissue.Aclientsystemininteractionwiththeenvironmentdelineatesthedomainofnursingconcerns.”

TheNeumanSystemsModelviewstheclientasanopensystemthatrespondstostressorsintheenvironment.Theclientvariablesarephysiological,psychological,sociocultural,developmental,andspiritual.Theclientsystemconsistsofabasicorcorestructurethatisprotectedbylinesofresistance.Theusuallevelofhealthisidentifiedasthenormallineofdefensethatisprotectedbyaflexiblelineofdefense.Stressorsareintra-,inter-,andextrapersonalinnatureandarisefromtheinternal,external,andcreatedenvironments.Whenstressorsbreakthroughtheflexiblelineofdefense,thesystemisinvadedandthelinesofresistanceareactivatedandthesystemisdescribedasmovingintoillnessonawellness-illnesscontinuum.Ifadequateenergyisavailable,thesystemwillbereconstitutedwiththenormallineofdefenserestoredat,below,oraboveitspreviouslevel.

Nursinginterventionsoccurthroughthreepreventionmodalities.Primarypreventionoccursbeforethestressorinvadesthesystem;secondarypreventionoccursafterthesystemhasreactedtoaninvadingstressor;tertiarypreventionoccursaftersecondarypreventionasreconstitutionisbeingestablished.

Assumptions Thefollowingaretheassumptionsor“acceptedtruths”madebyNeuman’sSystemsModel:

• Eachclientsystemisunique,acompositeoffactorsandcharacteristicswithinagivenrangeofresponses.

• Manyknown,unknown,anduniversalstressorsexist.Eachdiffersinitspotentialfordisturbingaclient’susualstabilitylevelornormallineofdefense.Theparticularinterrelationshipsofclientvariablesatanypointintimecanaffectthedegreetowhichaclientisprotectedbytheflexiblelineofdefenseagainstpossiblereactiontostressors.

• Eachclient/clientsystemhasevolvedanormalrangeofresponsestotheenvironmentthatisreferredtoasanormallineofdefense.Thenormallineofdefensecanbeusedasastandardfromwhichtomeasurehealthdeviation.

• Whentheflexiblelineofdefenseisnolongercapableofprotectingtheclient/clientsystemagainstanenvironmentalstressor,thestressorbreaksthroughthenormallineofdefense.

• Theclient,whetherinastateofwellnessorillness,isadynamiccompositeoftheinterrelationshipsofthevariables.Wellnessisonacontinuumofavailableenergytosupportthesysteminanoptimalstateofsystemstability.

• Implicitwithineachclientsystemareinternalresistancefactorsknownaslinesofresistance,whichfunctiontostabilizeandrealigntheclienttotheusualwellnessstate.

• Primarypreventionrelatestogeneralknowledgethatisappliedinclientassessmentandintervention,inidentificationandreductionormitigationofpossibleoractualriskfactorsassociatedwithenvironmentalstressorstopreventpossiblereaction.

• Secondarypreventionrelatestosymptomatologyfollowingareactiontostressors,appropriaterankingofinterventionpriorities,andtreatmenttoreducetheirnoxiouseffects.

• Tertiarypreventionrelatestotheadjustiveprocessestakingplaceasreconstitutionbeginsandmaintenancefactorsmovetheclientbackinacircularmannertowardprimaryprevention.

• Theclientasasystemisindynamic,constantenergyexchangewiththeenvironment.(Neuman,1995)

Major Concepts of Neuman Systems Model Inthissection,wewilldefinethenursingmetaparadigmandthemajorconceptsinBettyNeuman’sNeumanSystemsModel.

Human being

Humanbeingisviewedasanopensystemthatinteractswithbothinternalandexternalenvironmentforcesorstressors.Thehumanisinconstantchange,movingtowardadynamicstateofsystemstabilityortowardillnessofvaryingdegrees.

Environment

Theenvironmentisavitalarenathatisgermanetothesystemanditsfunction.Theenvironmentmaybeviewedasallfactorsthataffectandareaffectedbythesystem.InNeumanSystemsModelidentifiesthreerelevantenvironments:(1)internal,(2)external,and(3)created.

• Theinternalenvironmentexistswithintheclientsystem.Allforcesandinteractiveinfluencesthataresolelywithinboundariesoftheclientsystemmakeupthisenvironment.

• Theexternalenvironmentexistsoutsidetheclientsystem.

• Thecreatedenvironmentisunconsciouslydevelopedandisusedbytheclienttosupportprotectivecoping.

Health

InNeuman’snursingtheory,Healthisdefinedastheconditionordegreeofsystemstabilityandisviewedasacontinuumfromwellnesstoillness.Whensystemneedsaremet,optimalwellnessexists.Whenneedsarenotsatisfied,illnessexists.Whentheenergyneededtosupportlifeisnotavailable,deathoccurs.

Nursing

Theprimaryconcernofnursingistodefinetheappropriateactioninsituationsthatarestress-relatedorinrelationtopossiblereactionsoftheclientorclientsystemtostressors.Nursinginterventionsareaimedathelpingthesystemadaptoradjustandtoretain,restore,ormaintainsomedegreeofstabilitybetweenandamongtheclientsystemvariablesandenvironmentalstressorswithafocusonconservingenergy.

Open System

Asysteminwhichthereisacontinuousflowofinputandprocess,outputandfeedback.Itisasystemoforganizedcomplexity,whereallelementsareininteraction.

Basic Stricture and Energy Resources

Thebasicstructure,orcentralcore,ismadeupofthosebasicsurvivalfactorscommontothespecies.Thesefactorsincludethesystemvariables,geneticfeatures,andstrengthsandweaknessesofthesystemparts.

Client Variables

Neumanviewstheindividualclientholisticallyandconsidersthevariablessimultaneouslyandcomprehensively.

• The physiological variable refers to the structure and functions of the body.

• The psychological variable refers to mental processes and relationships.

• The sociocultural variable refers to system functions that relate to social and culturalexpectations and activities.

• The developmental variable refers to those processes related to development over the lifespan.

• The spiritual variable refers to the influence of spiritual beliefs.

Flexible line of defense

Aprotectiveaccordion-likemechanismthatsurroundsandprotectsthenormallineofdefensefrominvasionbystressors.

Normal line of defense

Anadaptationallevelofhealthdevelopedovertimeandconsiderednormalforaparticularindividualclientorsystem;itbecomesastandardforwellness-deviancedetermination.

Lines of resistance

Protectionfactorsactivatedwhenstressorshavepenetratedthenormallineofdefense,causingareactionsynptomatology.

Subconcepts of Neuman Systems Model

Stressors Astressorisanyphenomenonthatmightpenetrateboththeflexibleandnormallinesofdefense,resultingineitherapositiveornegativeoutcome.

• Intrapersonal stressors are those that occur within the client system boundary and correlate with the internal environment.

• Interpersonal stressors occur outside the client system boundary, are proximal to the system, and have an impact on the system.

• Extrapersonal stressors also occur outside the client system boundaries but are at a greater distance from the system that are interpersonal stressors. An example is social policy.

Stability

Astateofbalanceorharmonyrequiringenergyexchangesastheclientadequatelycopeswithstressorstoretain,attain,ormaintainanoptimallevelofhealththuspreservingsystemintegrity.

Degree of Reaction

Theamountofsysteminstabilityresultingfromstressorinvasionofthenormallineofdefense.

Entropy

Aprocessofenergydepletionanddisorganizationmovingthesystemtowardillnessorpossibledeath.

Negentropy

Aprocessofenergyconservationthatincreasesorganizationandcomplexity,movingthesystemtowardstabilityorahigherdegreeofwellness.

Input/Output

Thematter,energy,andinformationexchangedbetweentheclientandenvironmentthatisenteringorleavingthesystematanypointintime.

Reconstitution

Thereturnandmaintenanceofsystemstability,followingtreatmentofstressorreaction,whichmayresultinahigherorlowerlevelofwellness.

Prevention as Intervention

Interventionmodesfornursingactionanddeterminantsforentryofbothclientandnurseintothehealthcaresystem.

• Primarypreventionoccursbeforethesystemreactstoastressor;itincludeshealthpromotionandmaintenanceofwellness.Primarypreventionfocusesonstrengtheningtheflexiblelineofdefensethroughpreventingstressandreducingriskfactors.Thisinterventionoccurswhentheriskorhazardisidentifiedbutbeforeareactionoccurs.Strategiesthatmightbeusedincludeimmunization,healtheducation,exercise,andlifestylechanges.

• Secondarypreventionoccursafterthesystemreactstoastressorandisprovidedintermsofexistingsymptoms.Secondarypreventionfocusesonstrengtheningtheinternallinesofresistanceand,thus,protectsthebasicstructurethroughappropriatetreatmentofsymptoms.Theintentistoregainoptimalsystemstabilityandtoconserveenergyindoingso.Ifsecondarypreventionisunsuccessfulandreconstitutiondoesnotoccur,thebasicstructurewillbeunabletosupportthesystemanditsinterventions,anddeathwilloccur.

• Tertiarypreventionoccursafterthesystemhasbeentreatedthroughsecondarypreventionstrategies.Itspurposeistomaintainwellnessorprotecttheclientsystemreconstitutionthroughsupportingexistingstrengthsandcontinuingtopreserveenergy.Tertiarypreventionmaybeginatanypointaftersystemstabilityhasbeguntobereestablished(reconstitutionhasbegun).Tertiarypreventiontendstoleadbacktoprimaryprevention.(Neuman,1995)

Strengths and Weaknesses BettyNeumanreportshernursingmodelwasdesignedfornursingbutcanbeusedbyotherhealthdisciplines,whichbothhasprosandcons.Asastrength,ifmultiplehealthdisciplinesusetheNeuman’sSystemModel,aconsistentapproachtoclientcarewouldbefacilitated.Asacon,ifthemodelisusefultoavarietyofdisciplines,itisnotspecifictonursingandthusmaynotdifferentiatethepracticeofnursingfromthatofotherdisciplines.

Strengths

• ThemajorstrengthoftheNeumanSystemsModelisitsflexibilityforuseinallareasofnursing–administration,education,andpractice.

• Neumanhaspresentedaviewoftheclientthatisequallyapplicabletoanindividual,afamily,agroup,acommunity,oranyotheraggregate.

• TheNeumanSystemsModel,particularlypresentedinthemodeldiagram,islogicallyconsistent.

• Theemphasisonprimaryprevention,includinghealthpromotion,isspecifictothismodel.

• Onceunderstood,theNeumanSystemsModelisrelativelysimple,andhasreadilyacceptabledefinitionsofitscomponents.

Weaknesses

• Themajorweaknessofthemodelistheneedforfurtherclarificationoftermsused.

• Interpersonalandextrapersonalstressorsneedtobemoreclearlydifferentiated.

Analysis ThedelineationofNeuman’sthreedefenselineswerenotclearlyexplained.Inreality,theindividualresistsstressorswithinternalandexternalreflexeswhichweremadecomplicatedwiththeformulationofdifferentlevelsofresistanceintheopensystemsmodelofNeuman.

Neumanmadementionofenergysourcesinhermodelaspartofthebasicstructure.ItcanbemoreofhelpwhenNeumanhasenumeratedallsourcesofenergythatsheispertainingto.Withsuch,newnursinginterventionsastotheprovisionofneededenergyoftheclientcanbeconceptualized.

Theholisticandcomprehensiveviewoftheclientsystemisassociatedwithanopensystem.Healthandillnessarepresentedonacontinuumwithmovementtowardhealthdescribedasnegentropicandtowardillnessasentropic.Heruseoftheconceptofentropyisinconsistentwiththecharacteristicsofentropywhichisclosed,ratherthananopensystem.

The following are the references and sources used for this guide:

1. Alligood,M.,&Tomey,A.(2010).Nursingtheoristsandtheirwork,seventhedition.MarylandHeights:Mosby-Elsevier.

2. DorothyE.JohnsonBiographicalFile.(n.d.).RetrievedAugust7,2014,fromhttps://www.mc.vanderbilt.edu/diglib/sc_diglib/archColl/1014.html

3. Johnson,D.E.(1959a).Aphilosophyofnursing.NursingOutlook,7(4),198–200.

4. Johnson,D.E.(1968).Oneconceptualmodelofnursing.Unpublishedlecture,VanderbiltUniversity,Nashville,TN.

5. Johnson,D.E.(1980).Thebehavioralsystemmodelfornursing.InMcEwen,M.andWills,E.(Ed.).Theoreticalbasisfornursing.USA:LippincottWilliams&Wilkins.

6. WillsM.Evelyn,McEwenMelanie(2002).TheoreticalBasisforNursing.Philadelphia.LippincottWilliams&Wilkins.

7. Andrew,H.A.andRoy,C.(1991).Overviewofthephysiologicmode.InGeorge,J.(Ed.).Nursingtheories:thebaseforprofessionalnursingpractice.Norwalk,Connecticut:Appleton&Lange.

8. Roy,C.andMcLeod,D.(1981)Thetheoryofthepersonasanadaptivesystem.InGeorge,J.(Ed.).Nursingtheories:thebaseforprofessionalnursingpractice.Norwalk,Connecticut:Appleton&Lange.

9. Roy,C.andAdrews,H.A.(1999).TheRoyadaptationmodel(2nded).InMcEwen,M.andWills,E.(Ed.).Theoreticalbasisfornursing.USA:LippincottWilliams&Wilkins.

10. Alligood,M.R.(2013).NursingTheory-E-Book:Utilization&Application.ElsevierHealthSciences.

11. Neuman,B.(1996).TheNeumansystemsmodelinresearchandpractice.NursingScienceQuarterly,9(2),67-70.[Link]

12. Neuman,B.(1995).Theneumansystemsmodel(3rded.).InMcEwen,M.andWills,E.(Ed.).Theoreticalbasisfornursing.USA:LippincottWilliams&Wilkins.

• NursingTheoriesandTheorists–TheUltimateNursingTheoriesandTheoristsGuideforNurses.

. Scenario:

1. How the six-nursing process affect your nursing care plan to a cardiovascular patient? 2. How the adaptation model helps the patients to comply with his/her treatment?