INTRODUCTION:
The Neuman Systems Model was originally developed in 1970 at the University of California, Los Angeles, by Betty Neumann, Ph.D., RN. It is based upon Neumann’s own personal philosophy, teaching, and experience. The goal of Neumann System model was to provide a holistic overview of the physiological, psychological, sociocultural, developmental and spiritual aspects of human beings.
One of the primary problem with the application of general systems theory to phenomena of interest to nursing is that “what” of assessment, intervention and evaluation is not identified. Neuman(1989)addressed this shortcoming by clearly identifying how the model relates to the nursing process rather than using the less meaningful general systems language of “input”, “throughputs”, and “feedback loops”. Neuman states that the model is “open to creative implementation. Although creative interpretations and implementation of the model are valued, structural changes that could alter its original meaning and purpose are not sanctioned”.
THE CONCEPTUAL MODEL: “
The Neumann systems model provides a comprehensive, flexible, holistic and system based perspective for nursing. This conceptual model for nursing focuses attention on the response of client system to actual or potential environmental stressors and the use of primary, secondary and tertiary nursing prevention interventions for retention attainment and maintenance of optimal client system wellness.”
The model was organized by the nursing meta paradigm concepts: person, environment, health and nursing. The aim of model is the development of a person in a state of wellness having the capacity to function optimally by adaptation with environmental stimuli causing illness back to state of wellness.
- Person: The concept of person in the Neuman model is called client-client system model .The person is a layered multidimensional being. Each layer consists of five person variables or subsystems:
- Physiological(refers of the physicochemical structure and function of the body).
- Psychological(refers to mental processes and emotions).
- Socio-cultural(refers to relationships; and social/cultural expectations and activities).
- Developmental(refers to those processes related to development over the lifespan).
- Spiritual(refers to the influence of spiritual beliefs).
The layers, usually represented by concentric circle, consist of the central core, lines of resistance, lines of normal defence, and lines of flexible defence. The basic core structure is comprised of survival mechanisms including: organ function, temperature control, genetic structure, response patterns, ego. Lines of resistance and two lines of defence protect this core. The person may in fact be an individual, a family, a group, or a community in Neuman's model. The person, with a core of basic structures, is seen as being in constant, dynamic interaction with the environment. Around the basic core structures are lines of defence and resistance (shown diagrammatically as concentric circles, with the lines of resistance nearer to the core. The person is seen as being in a state of constant change and-as an open system-in reciprocal interaction with the environment (i.e. affecting, and being affected by it).
Central Core:
The basic structure, or central core, is made up of the basic survival factors that are common to the species (Neuman, 1995, in George, 1996). These factors include: system variables, genetic features, and the strengths and weaknesses of the system parts. Examples of these may include: hair color, body temperature regulation ability, functioning of body systems homoeostatic, cognitive ability, physical strength, and value systems. The person's system is an open system and therefore is dynamic and constantly changing and evolving. Stability, or homoeostasis, occurs when the amount of energy that is available exceeds that being used by the system. A haemostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance.
Lines of Resistance: The lines of resistance protect the basic structure and become activated when environmental stress ors invade the normal line of defence. Example: activation of the immune response after invasion of micro-organisms. If the lines of resistance are effective, the system can reconstitute and if the lines of resistance are not effective, the resulting energy loss can result in death.
Line of Normal Defence: The normal line of defence represents system stability over time. It is considered to be the usual level of stability in the system. The normal line of defence can change over time in response to coping or responding to the environment. An example is skin, which is stable and fairly constant, but can thicken into a callus over time.
Lines of Flexible Defence: The flexible line of defense is the outer barrier or cushion to the normal line of defense, the line of resistance, and the core structure. If the flexible line of defence fails to provide adequate protection to the normal line of defence, the lines of resistance become activated. The flexible line of defence acts as a cushion and is described as accordion-like as it expands away from or contracts closer to the normal line of defence. The flexible line of defence is dynamic and can be changed/altered in a relatively short period of time.
- Environment: Neumann model consist of the following topology: internal, external or created. Internal and External environment include the intrapersonal, interpersonal and extrapersonal stress ors which can affect the person's normal line of defense and so can affect the stability of the system.
- The internal environment exists within the client system.
- The external environment exists outside the client system.
- The created environment unconsciously developed by the client to protect from intrapersonal, interpersonal, extrapersonal stressors and maintain system stability.
Stressors are capable of having either a positive or negative effect on the client system. A stressor is any environmental force which can potentially affect the stability of the system: they may be:
- Intrapersonal - occur within person, e.g. emotions and feelings
- Interpersonal - occur between individuals, e.g. role expectations
- Extrapersonal - occur outside the individual, e.g. job or finance pressures
The person has a certain degree of reaction to any given stressor at any given time. The nature of the reaction depends in part on the strength of the lines of resistance and defense. By means of primary, secondary and tertiary interventions, the person (or the nurse) attempts to restore or maintain the stability of the system.
- Health: Health is equated with wellness. She defines health/wellness as "the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman, 1995)". As the person is in a constant interaction with the environment, the state of wellness (and by implication any other state) is in dynamic equilibrium, rather than in any kind of steady state.
Neuman proposes a wellness-illness continuum, with the person's position on that continuum being influenced by their interaction with the variables and the stressors they encounter. The client system moves toward illness and death when more energy is needed than is available. The client system moves toward wellness when more energy is available than is needed.
- Nursing: Neuman states that nursing is a “unique” profession concerned with the interrelationship of all “variables affecting a client’s possible are an actual response to stressors”. Neuman defines that nursing can help “individuals, families and groups to retain, attain and maintain a maximum level of wellness”. The primary aim is stability of the client system, through nursing interventions to reduce stressors and when a stressor reaction occurs, the secondary aim is the treatment of symptoms. The tertiary aim to help the client to reconstitute and maintain the current level of wellness. The nursing process within the Neuman model consists of three components: Nursing Diagnosis, Goals and Outcomes.
- Nursing Diagnosis– A large component of the nursing diagnosis phase of Neuman nursing process involves nurse assessment of all factors influencing the client .The perception of client and nurse may vary widely and thereby influence appropriate interventions, active client participation is essential to validate the meaning of a client’s experience with the nurse.
- Nursing Goals – This decision results from collaborative negotiation with the patient, and take account of patient's and nurse's perceptions of variance from wellness
- Nursing Outcomes – Actual outcomes are the result of the effectiveness of selected interventions and are evaluated in relation to mutually set goals.
The nurse’s role in relation to assessment and intervention varies depending upon the type of intervention (primary, secondary or tertiary)that is needed.
- Primary: Primary prevention occurs before the system reacts to a stressor. On the one hand, it strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors, and on the other hand manipulates the environment to reduce or weaken stressors. Primary prevention includes health promotion and maintenance of wellness.
- o Secondary: Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing systems. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor.
- o Tertiary: Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.
APPLICATION:
Research: Neuman’s System Model is being used in Nursing research that guides enhancement of nursing care.
Nursing Education:
- Effective in conceptual transition among all levels of nursing education.
- Basis for continuing education after graduation facilitating professional growth.
- Validate nursing roles and activities and its applicability beyond nursing practice.
Nursing Practice: Holistic approach in the care of the patients.
CONCLUSION:
Neuman has presented a comprehensive and systematic approach for organizing nursing phenomena that is based on tested scientific findings from multiple disciplines. It is a valuable model for understanding relationships between clients and their environments.
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