Betty Neuman's systems model and patient-centered nursing care

¶ … Betty Neuman's Systems Model, middle-range theory

Betty Neuman was born in Lowel, Ohio in 1924 (Nursing Theory, 2013; Current Nursing, 2012). In 1947, she first earned a diploma as registered nurse from the People's Hospital School in Akron, Ohio. This was followed by a Bachelor of Nursing degree in 1957 and a Master of Science in Mental Health in 1966, both at the University of California in Los Angeles, and a PhD in clinical psychology at the Pacific Western University in 1985. She was further decorated with an honorary Doctorate of Letters at the Neuman College in Aston, Pennsylvania and anoher honorary doctorate, this time, of science at the Grand Valley State University in Michigan in 1998 (Nursing Theory, Current Nursing).

Neuman's first job was as a pioneering nurse in community mental health (Nursing Theory, 2013; Current Nursing, 2012). She also worked as a lecturer at the University of California in Los Angeles while developing her systems model, her masterwork. This model was the subject of her first book, entitled The Neuman Systems Model, published in 1982. Its major contents were a nursing process format and care plans, by itself a comprehensive approach to patient care.

She lectured and wrote about this Model to both nurses and professors (Nursing Theory, Current Nursing).

B. Theory Description

1. Reasoning: Inductive, Deductive or Retroductive -- Inductive -- If an ill or injured person is viewed and dealt with as a complete person, instead of, and despite, his or her condition, he or she tends to cooperate better with his or her treatment and recovery. The general idea is that every patient or person is a complete entity and must be viewed this way before any specific dealings can succeed with him or her. In the case of healthcare, the patient or client needs and wants to be viewed as a person who happens to be ill and needing specific care.

2. Major Concepts, Consistency in their Use -- The Model, on the whole, focuses on the patient's response to stress and the factors, which trigger it (Gigliotti, 2011; Nursing Theory, 2013; Current Nursing, 2012; Gonzalo, 2011). It was readily accepted and earned popularity for its universal appeal and applicability to most situations as well as interpretability in many forms. Neuman's Model philosophy rests on energy resources, which sustain three different and progressive lines of defense. The first consists of lines of resistance, composed in turn of internal factors, which attempt to throw off or defeat a stressor. The second is the person's equilibrium or normal line of defense. And the third and last is a flexible and time-dependent, changeable line of defense that sets in when the first two lines of defense are unable to deal with the stressor effectively (Gigliotti, Nursing Theory, Current Nursing, Gonzalo).

The Systems Model content deals with the dynamics of the patient's interaction with factors and circumstances within his internal and external environment, representing the entire client system (Current Nursing, 2012; Gigliotti, 2003). Basic to it are survival factors or a person's basic energy resources. These are physiological and psychological in nature. They include normal body temperature range, genetic makeup, pattern of response to stimuli, strength or weakness of the person's physiological organs, and ego structure. The person is in a stable state, also called homeostatis, when the combination of available physical and emotional or psychic energy exceeds that which is being used by the system. In a reverse condition, injury, sickness or disorder of the body or mind occurs (Current Nursing, Gigliotti).

3. Implicit or Explicit Definition of the Concepts, Relationships among Major Concepts - The three levels of defense represent the system's response to stimuli, which it perceives and affect it within his internal and/or external environment (Gonzalo, 2001; Current Nursing, 2012; Nursing Theory, 2013). When a stimulus appears or is perceived by the client or system, it responds to it either positively or negatively. If the response is positive, it accepts the effects of the stimulus. If negative, its first line of defense rejects and throws it out of its environment. Its function is to protect the equilibrium and integrity of the person or system by filtering off what it considers harmful or unpleasant. At the same time, this first line reinforces the flexibility of the last or third line of defense. The secondary line of defense fortifies internal lines of resistance in the event that the disturbing or harmful stimulus breaks down the protective mechanism of the first line and penetrates the second line. The secondary line or level of defense continues the fight by reducing the system's adverse reaction and increase or strengthens resistance factors. But when the stimulus is able to break through the secondary level or line, the tertiary level takes over and readapts, stabilizes, installs and protects the system's recovery following therapy (Current Nursing, Nursing Theory).

D. Application

1. How It Guides Nursing Actions - The Model or System Theory provides the nurse with a comprehensive, flexible, holistic and systematic point-of-view for her career (Current Nursing, 2012; Nursing Theory, 2013; Gigliotti, 2003). It educates the nurse on the characteristics of a client's internal and external responses to actual or potential stressor in his internal or external environment. The nurse is given the opportunity to understand and apply Neuman's three levels of defense in a client's reaction to a given stressor. An understanding and the application of these three levels of defense enables the nurse to help retain, attain and maintain optimal system wellness. It gives her a brand-new vision of what makes a human being and what makes him well or unwell (Current Nursing, Gonzalo).

2. How to use this Theory in your area in Nursing (practice, education, informatics or administration) - The characteristics of this middle-range theory make it useful in all the aspects of patient care. Its interrelated concepts provide a fresh, thorough and unique view of the human person and what makes him well or unwell. The clarity of the interrelatedness of the variables or sub-systems of the human personality gives the nurse a better direction and confidence in providing precise patient care. The characteristics of the Model or Theory are also logical and consistent and are, thus, easy to follow. At the same time, the levels are arranged in logical sequence, which is easy to memorize. The Model or Theory is also simple and straightforward with nothing too new or complex. It lifts the nurse's awareness of the human person in the client as well as her own. Neuman's definitions are, most of all, easily identifiable and comprehensible. They are very educational to the nurse in her practice as well as in private life. And it is certainly practicable and pertinent to the nursing profession. In addition to its value to the nursing practice and education, Neuman's Model or Theory is just as valuable to nurse administrators who must supervise and assess the work of nurses under them to see clients as they should be seen. #