Nursing Theory in Nursing Decision-Making

Nursing Theory in Nursing Decision-Making Practice: Betty Neuman's systems model When faced with a patient undergoing a health crisis, the first thing that occurs to the nurse practitioner or APN is usually not what nursing theory to apply to the situation, but what practical health care solution is necessary to aid the patient? However, having a theoretical framework to guide a nurse's decision-making process can be useful in the often-pressured scenarios nurses find themselves in today.

An appropriate decision-making framework help the nurse develop a more complete, fluent, as well as expedient analysis of a patient's health and personal situation. Nursing theorist Betty Neuman offered a theory of nursing that treated the patient as a constellation of interrelated physiological, psychological, socio-cultural, spiritual, and developmental needs. The "Neuman Systems Model," as she called her approach, was intended to be a unique, systems-based perspective that provided a unifying focus for approaching a wide range of nursing concerns in situations from the emergency room to the school nurse's office.

(Neuman, 1990) the Neuman Systems Model was focused upon clarifying the often-dizzying array of relationships of patient variables present when a nurse is dispensing care. It tried to help provide useful and flexible role definitions for nursing at various levels of nursing practice, which may vary from context to context.

According to its founder, Betty Neuman, the multidimensionality and holistic systemic perspective of the Neuman Systems Model is increasingly demonstrating its relevance and reliability in a wide variety of clinical and educational settings throughout the world, as the demands upon nurses grow.

(1995) an example of Neuman's decision making in action might occur when a nurse is confronted with a patient who says he or she is in pain after a car accident, and demands more pain medication, despite the fact that the patient has just been recently treated with such medication. Neuman's framework would suggest that it might be useful for the APN to probe a bit and ask if the patient is experiencing anxiety about his or her rehabilitation, or guilt over what transpired during the accident.

The patient may be in pain, but also may be somaticizing some of the mental pain and anguish he or she feels. Neuman advises the nurse, when making decisions, to treat the patient as a variety of interactive variables. Neuman theorized that the mind (psychological variable) influences the body (physiological variable) through the spirit (spiritual variable).

If one doubts the applicability of Neuman's proposition of the interrelationship of all such variables, only consider how mental anxiety can spike the patient's heart rate, or the physical pains of labor can cause an ordinarily loving wife to lash out at a well-meaning husband -- or how the spiritual state of grief can precipitate depression and ill health in the hearts of the loved ones of a deceased patient.

A nurse must weigh these variables, physical, mental, and spiritual, when advising a course of treatment and deciding how to approach a patient or patient's family. An adolescent who is an injured athlete envisioning a lucrative college scholarship might demand and be able to physically and mentally withstand a more aggressive form of treatment, due to psychological and developmental and goal-related visions (spiritual) factors than might a less motivated elderly patient.

A nurse who is training other nurses can instill consideration for all such variables in her various trainees -- and encourage nurses to engage in self-care as well as patient care on spiritual, preventative physical health care, and mental levels. Additionally, in a work environment with many diverse cultures, remind other nurses that Neuman's model has also been modified slightly to take into consideration culture as well as mind, body, and spirit -- although culture and spiritual values are difficult to separate.

Some cultural frameworks affecting nursing practice might be due to a family asking to be more involved and present during intimate moments of treatment, or affect the way that pain, treatment, and the end or beginning.