Neuman Systems Model
Roline CampbellRoxy JohanningTracy Hill
Presentation Objectives:
1. Introduce Betty Neuman
2. Overview of the Neuman Systems Model (NSM) it’s concepts and principles
3. Evaluate the NSM nursing theory using Fawcett’s criteria
4. Compare the NSM with two other nursing theories
5. Discuss and analyze the use of the NSM
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.
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.
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)
“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, 2002Betty Neuman as keynote speaker at the
University of Maine, Fort Kent in 2004.
An Overview of the Neuman Systems
Model
Philosophical Claims
o Wholism
o Wellness orientation
o Client perception and motivation
o Dynamic systems perspective of
energy & variable interaction with
the environment
o Client & caregiver in partnership
Key Concepts
Classified according to the applicable metaparadigm forerunner.
Human Beings
• Client/Client System
• Interacting Variables
• Basic Structure
• Flexible line of Defense
• Normal line of Defense
• Lines of Resistance
Environment
• Internal Environment
• External Environment
• Created Environment
• Stressors
Health
• Health/Wellness/ Optimal Client System Stability
• Variances from Wellness
• Illness• Reconstitutio
n
Nursing
• Prevention as Intervention
Client/Client Systemo Viewed as open systemo Repeated cycles of input, process,
output & feedbacko Thus a dynamic organizational patterno Can be• Individual• Family• Group• Community• Aggregate (Social Issue)
Interacting Variables
Spiritual
Psychological
Physiological
Socio-cultural
Developmental
Present in each type of client
Consider thesesimultaneously & comprehensively
Basic survival factors
Normal temp rangeGenetic StructureResponse pattern
Organ strength/weaknessEgo structure
Central Core
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
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
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
Internal Environment
Forces & interactive influences
confined within client system
IntrapersonalStressors
External Environment
Forces & interaction influences
existing outside the client system Extra-personal
stressorsInterperso
nal
stresso
rs
Created Environment
Symbolic expression of
system wholeness
Unconscious mobilization of all system variables
Interpersonal
Intr
aper
so
nalExtra-
personal
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.
Prevention as Intervention
o Basis for health promotiono Nursing is prevention as interventiono Three dimensions• Primary prevention• Secondary prevention• Tertiary prevention
Primary Prevention
o Health promotion & Maintenance of
wellness
o Occurs before the system reacts to a
stressor
o Strengthens the client / client system to
better deal with stressors (FLD)
o May also try to manipulate the
environment to reduce or weaken stressors
Secondary Prevention
o Focus on preventing damage to the
Central Core
o Occurs after the system reacts to a
stressor
o Aims to strengthen the Lines of Resistance
o May also try to remove the stressor
Tertiary Prevention
o Occurs after the client/client system has
been treated through secondary prevention
strategies
o Offers support to the client
o Attempts to:
• add energy to the system or
• reduce energy needed in order to
facilitate reconstitution
ReconstitutionThe determined energy increase related
to the degree of reaction to a stressorRepresents the return and maintenance of
system stability following treatmentMay be viewed as feedback from the
input/output of secondary preventionComplete 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
Jacqueline Fawcett and Betty Neuman at the 8th Neuman Systems Model Symposium
- Salt Lake City, 2001
Evaluation
of theNeuman SystemsModel
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.
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.
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.
Fawcett’s Criteria to Evaluate Nursing Theory
SignificanceInternal
ConsistencyParsimonyTestabilityEmpirical
AdequacyPragmatic
Adequacy
Significance - Meets
Metaparadigm concepts & propositions are explicitly stated
All philosophical claims are addressedSupport 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
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.
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.
Testability - MeetsThe 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.
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.
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).
Comparison of NSM with two other nursing
theories / models
ComparisonRogers (1970)Science
of Unitary Human Beings
Neuman
(1970)Neuman’s System
Model
Roy (1970)Roy’s
Adaptation Model
Contemporaries of one another
Martha Rogers
Betty Neuman
Sister Callista
Roy
Each Define the Metaparadigm Concepts:
PersonEnvironmentHealth Nursing
Each Used in Nursing:
PracticeAdministrationEducation
Theories derived from:
Martha Rogers• Six
Grand theories and 12 Middle-range theories based on SUHB (Fawcett, 2005, p. 332-333)
Betty Neuman• Two
Grand Theories and Three Middle-range theories based on NSM (Fawcett, 2005, p. 184)
Sister Callista Roy• One
Grand theory and Nine Middle-range theories based on RAM (Fawcett , 2005, p. 389, 392-93)
Goal of Nursing
To Promote Human Betterment wherever People Are, on Planet Earth or in Outer Space.
(Fawcett, 2005, p. 316)
To Facilitate Optimal Wellness for the Client Through Retention, Attainment, or Maintenance
of Client System Stability. (Fawcett, 2005, p. 167)
To Promote Adaptation for Individuals and Groups in the Four Adaptive Modes, Thus
Contributing to Health, Quality of Life, and Dying with Dignity by Assessing Behavior and Factors
That Influence Adaptive Abilities and by Intervening to Expand those Abilities and to
Enhance Environmental Interactions (Fawcett,2005, p. 365)
OverviewFocus is on unitary,
irreducible human beings & their environments.
(Fawcett, 2005, p. 315)
Focus is on wellness of client system in relation to
environmental stressors and reactions to the stressors. (Fawcett, 2005, p. 166)
Focus is on human adaptive system responses and
environmental stimuli, which are constantly changing. (Fawcett, 2005, p. 365)
WorldviewReflects the
simultaneous action worldview
Reflects the reciprocal interaction worldview
Reflects the reciprocal interaction worldview
Reciprocal Interaction WorldviewThis 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)
Simultaneous Action World ViewThis world view combines elements of theorganismic, simultaneity, change and unitary-
transformative world views:Unitary human beings are identified by patternHuman 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)
Meets Fawcett’s Criteria for Evaluation of Nursing Models
RogersRoyNeuman
(Fawcett 2005, p. 57-58)
Rogers Roy
Neuman
Selection Rationale
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)
Discussion Points
Steps taken to ensure the Continued Evolution of the NSM
Establishment of the NSM Trustees Group◦Support & promote the NSM through
scholarly work & professional forumsEstablisment of the NSM Archives at
Neumann College in Aston, Pennsylvania◦Facilitates access to important documents
Establishment of the Neuman Institute◦Enhance continuation of NSM-based
scholarly work