Betty Neuman The System Model Theory.pdf

Betty Neuman: The System Model Theory Page 1 of 68 Betty Neuman: The System Model Theory Page 2 of 68  Betty Neuman’s THE SYSTEM MODEL THEORY BALANSAG, BARRON, BEJASA BOLAY-OG Betty Neuman: The System Model Theory Page 3 of...

Betty Neuman: The System Model Theory Page 1 of 68 Betty Neuman: The System Model Theory Page 2 of 68  Betty Neuman’s THE SYSTEM MODEL THEORY BALANSAG, BARRON, BEJASA BOLAY-OG Betty Neuman: The System Model Theory Page 3 of 68  BETTY NEUMAN “The person is a complete system with interrelated parts; maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli” Betty Neuman: The System Model Theory Page 4 of 68  BACKGROUND OF THE THEORIST In 1924, she was born near Lowell, Ohio Her father was a farmer who became sick and later died at the age of 36. Her mother was a self-educated midwife Her love for nursing started when she took the responsibility of taking care of her father Betty Neuman: The System Model Theory Page 5 of 68  BACKGROUND OF THE THEORIST In 1947, she graduated with a nursing diploma from Peoples Hospital School of Nursing in Akron, Ohio. In 1957, she received a baccalaureate degree in public health and psychology with honors from the University of California at Los Angeles (USLA) Betty Neuman: The System Model Theory Page 6 of 68  BACKGROUND OF THE THEORIST In 1966, she received a master's degree in Mental Health, Public Health Consultation from UCLA In 1970, she began developing the Neuman system Model In 1985, she concluded a doctoral degree in clinical psychology at Pacific Western University Betty Neuman: The System Model Theory Page 7 of 68  MAJOR AWARDS OF THE THEORIST Honorary Doctorate of Letters Awarded by Neumann College Pennsylvania in 1992 Honorary Member of the Fellowship Awarded by the American Academy of Nursing (AAN) in 1992 Honorary Doctorate of Science Awarded by the Grand Valley State University, Michigan in 1998 Betty Neuman: The System Model Theory Page 8 of 68  PUBLISHED BOOKS 1st - The Neumans Systems Model (1982) Author: Betty Neuman 2nd - Neuman Systems Model: Application to Nursing Education and Practice (1989) Author: Betty Neuman, B. M. Fawcett Betty Neuman: The System Model Theory Page 9 of 68  PUBLISHED BOOKS 3rd - The Neuman Systems Model in Research and Practice (1995) Authors: Betty Neuman, Donna M. J. Fitzpatrick 4th - Neuman Systems Model: A Nursing Perspective (2002) Authors: Betty Neuman Betty Neuman: The System Model Theory Page 10 of 68  NEUMAN’S SYSTEMS MODEL: MAJOR CONCEPTS AND DEFINITIONS Betty Neuman: The System Model Theory Page 11 of 68  1) Wholistic Approach The Neuman systems model is a dynamic, open, systems approach to client care originally developed to provide a unifying focus for defining nursing problems and for understanding the client in interaction with the environment. The client as a system may be defined as a person, family, group, community, or social issue. Clients are viewed as wholes whose parts are in dynamic interaction. The model considers all variables simutaneously affecting the client system: physiolgical, psychological, sociocultural, developmental, and spiritual. Neuman included the spiritual variable in the second edition. She changed the spelling of the term holistic to wholistic in the second edition to enhance understanding of the term as referring to the whole person. Betty Neuman: The System Model Theory Page 12 of 68  2) Open System A system is open when “there is a continuous flow of input and process, output, and feedback.” “Stress and reaction to stress are basic components” of an open system. Betty Neuman: The System Model Theory Page 13 of 68  Function of Process The client as a system exchanges “energy, information, and matter with the environment as well as other parts and subparts of the system” as it uses available energy resources “to move toward stability and wholeness”. Betty Neuman: The System Model Theory Page 14 of 68  Input and Output For the client as a system, input and output are “the matter, energy, and information that are exchanged between the client and the environment”. Betty Neuman: The System Model Theory Page 15 of 68  Feedback System output in the form of “matter, energy, and information serves as feedback for future input for corrective action to change, enhance, or stabilize the system”. Betty Neuman: The System Model Theory Page 16 of 68  Negentropy “A process of energy conservation that increases organization and complexity, moving the system toward stability at a higher degree of wellness”. Betty Neuman: The System Model Theory Page 17 of 68  Stability A dynamic and “desirable state of balance in which energy exchanges can take place without disruption of the character of the system”, which point to optimal health. Betty Neuman: The System Model Theory Page 18 of 68  Environment It is defined by Neuman, “the environment consists of both internal and external forces surrounding the client, influencing and being influenced by the client, at any point in time” Betty Neuman: The System Model Theory Page 19 of 68  Created Environment It is developed unconsciously by the client to express system wholeness symbolically. Purpose: to provide perceptual protection for client system functioning and to maintain system stability. Betty Neuman: The System Model Theory Page 20 of 68  4) Client System It is a composite of five variables (physiological, psychological, sociocultural, developmental, and spiritual) in inetraction with the environment. 1. Physiological variable - refers to the body structure and function 2. Psychological variable - refers to the mental process in interaction with the environment. 3. Sociocultural variable - refers to the effects and influences of social and cultural conditions. 4. Developmental variable - refers to age-related processes and activites 5. Spiritual variables - refers to the spiritual beliefs and influences. Betty Neuman: The System Model Theory Page 21 of 68  Basic Structure The client as a system is composed of a central core surrounded by concentric rings. The inner circle of the diagram represents the basic survival factors or energy resources of the client. Betty Neuman: The System Model Theory Page 22 of 68  Lines of Resistance A series of broken rings surrounding the basic core structure. The rings represent resource factors that help the client defend against a stressor. Betty Neuman: The System Model Theory Page 23 of 68  5) Normal Line of Defense It is the model’s outer solid circle. It represents the “adaptional level of health developed over the course of time and serves as the standard by which to measure wellness deviation determination” Betty Neuman: The System Model Theory Page 24 of 68  6) Flexible Line of Defense It is the model’s outer broken ring. A protective buffer for preventing stressors form breaking through the usual wellness state as represented by normal line of defense. Client’s first protective mechanism. Betty Neuman: The System Model Theory Page 25 of 68  7) Health A continuum of wellness to illness that is dynamic in nature. Optimal wellness exists when the total system needs are being completely met. Betty Neuman: The System Model Theory Page 26 of 68  Wellness “Wellness exist when all system subparts interact in harmony with the whole system and all system needs are being met” Illnes “Ilness exists at the opposite end of the continuum from wellness and represents a state of instability and energy depletion” Betty Neuman: The System Model Theory Page 27 of 68  8) Stressors Are tension-producing stimuli "that have the potential to disrupt system stability, leading to am outcome that may be positive or negative." They may arise from the following: 1. Intrapersonal forces occuring within the individual, "such as conditioned responses" 2. Interpersonal forces occuring "between one or more individuals, such as role expectations" 3. "Extrapersonal forces occuring outside the individual, such as financial circumstances" Betty Neuman: The System Model Theory Page 28 of 68  9) Degree of Reactions “The degree of reactions represents system instability that occurs when stressors invade the normal line of defense” Betty Neuman: The System Model Theory Page 29 of 68  10) Prevention as Intervention Purposeful actions to help the client retain, attain, or maintain stability. They can occur before or after protective line of defense and resistance are penetrated. Betty Neuman: The System Model Theory Page 30 of 68  Three levels of Intervention: 1. Primary intervention Is used when a stressor is suspected or identified "A reaction has not yet occured, " but the degree of risk in known. The purpose is to reduce the possibility of encounter with the stressor or to decrease the possibility of a reaction. 2. Secondary Intervention "Involves interventions or treatment iniated or treatment iniated after symptoms from stress have occured." The clients internal and external resources are used to strengthen internal lines of resistance, reduce the reaction, and increase resistance factors. 3. Tertiary Intervention “Occurs after the active treatment or s3condary prevention stage. It focuses on readjustment toward optimal client system stability." The goal is to maintain optimal wellness by preventing reccurence of reaction or regression. Tertiary prevention leads back in a circular fashion toward primary prevention. Betty Neuman: The System Model Theory Page 31 of 68  11) Reconstruction Occurs after treatment for stressor reactions. "It represents return of the system to stability" which may be at a higher or lower level of wellness than before stressor invasion Betty Neuman: The System Model Theory Page 32 of 68  I. Person Variable Betty Neuman: The System Model Theory Page 33 of 68  I. Person Variable as 1.1 Physiological Variable Refers to the body’s physical functions and structures, including health, bodily processes, and physiological responses. Betty Neuman: The System Model Theory Page 34 of 68  I. Person Variable 1.2 Psychological Variable as It involves mental processes, emotions, cognition, and psychological well-being, impacting how a person thinks, feels, and behaves. Betty Neuman: The System Model Theory Page 35 of 68  I. Person Variable 1.3 Development Variable as Relates to the individual’s growth and development stages throughout life, including age-related changes and maturation. E.g, Empty Nest Syndrome, Sandwich generation Betty Neuman: The System Model Theory Page 36 of 68  I. Person Variable 1.4 Sociocultural Variable as It encompasses social and cultural influences, such as relationships, societal norms, customs, and roles that affect the person. Betty Neuman: The System Model Theory Page 37 of 68  I. Person Variable 1.5 Spiritual Variable as Pertains to beliefs, values, purpose, and connection to a higher power or life meaning, which provide comfort and inner strength. Betty Neuman: The System Model Theory Page 38 of 68  II. Central Core Betty Neuman: The System Model Theory Page 39 of 68  II. Central Core The basic structure or central core is made up of the basic "survival factors". as These factors include: a. System variables b. Genetic features, and c. The strengths and weaknesses of the system parts. Examples are hair color, body temperature regulation ability, functioning of body systems homeostatically, cognitive ability, physical strength, and value systems. Betty Neuman: The System Model Theory Page 40 of 68  II. Central Core The person's system is an asopen system and therefore is dynamic and constantly changing and evolving. Stability or homeostasis occurs when the amount of energy that is available exceed that being used by the system. A homeostatic body system is consistently in a dynamic process of input, output, feedback, and compensation which leads to a state of balance. Betty Neuman: The System Model Theory Page 41 of 68  III. Flexible Line of Defense Betty Neuman: The System Model Theory Page 42 of 68  III. Flexible Line of Defense The flexible line of defense is the outer barrier or cushion to the normal line of defense,asthe line of resistance, and the core structure. If the flexible line of defense fails to provide adequate protection to the normal life of defense, the lines of resistance become activated. The flexible line of defense acts as a cushion and is described as accordion-like as it expands away from or contracts closer to the normal line of defense. The flexible line of defense is dynamic and can be changed/altered in relatively short period of time. Betty Neuman: The System Model Theory Page 43 of 68  IV. Normal Line of Defense Betty Neuman: The System Model Theory Page 44 of 68  IV. Normal Line of Defense The normal line of defense represents system stability as over time. It is considered to be the usual level of stability in the system. The normal line of defense can change over time in response to coping or responding to the environment. An example is the skin, which is stable and fairly constant but can thicken into a callus over time. Betty Neuman: The System Model Theory Page 45 of 68  V. Lines of Resistance Betty Neuman: The System Model Theory Page 46 of 68  V. Lines of Resistance as Protect the basic structure and become activated when environmental stressors invade the normal line of defense. If effective, the system can reconstitute and if the lines of resistance are not effective, the resulting energy loss can result in death. Betty Neuman: The System Model Theory Page 47 of 68  VI. Reconstitution Betty Neuman: The System Model Theory Page 48 of 68  VI. Reconstitution as The increase in energy that occurs in relation to the degree of reaction to the stressor. May expand the normal line of defense beyond it previous level, stabilize the system at a lower level, or return it to the level that existed before the illness. Betty Neuman: The System Model Theory Page 49 of 68  VII. Stressors Betty Neuman: The System Model Theory Page 50 of 68  VII. Stressors The Neuman Systems Model focuses on the impact of stressors on health and addresses stress and reduction of stress(in the form of stressors). as 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: 1. Intrapersonal - occur within the person 2. Interpersonal - occur between individuals 3. Extra personal - occur outside the individual Betty Neuman: The System Model Theory Page 51 of 68  VIII. Prevention Betty Neuman: The System Model Theory Page 52 of 68  VIII. Prevention Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body. as 1. Primary Prevention - occurs before the system reacts to a stressors 2. Secondary Prevention - occurs after the system reacts to a stressors and is provided in terms of existing systems. 3. Tertiary Prevention - occurs after the system has been treated through secondary prevention strategies. Betty Neuman: The System Model Theory Page 53 of 68  NEUMAN’S SYSTEMS MODEL: MAJOR ASSUMPTIONS Betty Neuman: The System Model Theory Page 54 of 68  Human Beings (Person/Client) Neuman views the client (individual, family, group, or community) as an open system in constant interaction with the environment. This system consists of layers: 1. Physical, 2. Psychological, 3. Socio-cultural, 4. Developmental, and 5. Spiritual Represented as concentric circles with a core of survival mechanisms. The client both affects and is affected by the environment. Betty Neuman: The System Model Theory Page 55 of 68  Health Health is seen as wellness, where all parts of the client system are in harmony. Neuman proposes a wellness- illness continuum, where the client's position is determined by their energy balance and interaction with stressors. Optimal wellness occurs when system needs are met. Betty Neuman: The System Model Theory Page 56 of 68  Environment The environment includes internal, external, and created factors. These environments influence the client system’s stability. Stressors (intrapersonal, interpersonal, and extrapersonal) are significant environmental forces that can disrupt this stability. Betty Neuman: The System Model Theory Page 57 of 68  Nursing Nursing's primary aim is to maintain or restore the client’s wellness by addressing all variables that influence responses to stressors. Nurses use primary, secondary, and tertiary interventions to reduce stressors and stabilize the client system, while also considering both the nurse's and the client's perceptions. Betty Neuman: The System Model Theory Page 58 of 68  THE NEUMAN SYSTEM MODEL’S DIAGRAM Betty Neuman: The System Model Theory Page 59 of 68 Betty Neuman: The System Model Theory Page 60 of 68  PRIMARY STRESSORS PREVENTION STRESSORS BASIC STRUCTURE AND LINE OF DEFENSE SECONDARY PREVENTIONS REACTION STRESSORS TERTIARY PREVENTIONS RECONSTITUTION INTERVENTIONS Betty Neuman: The System Model Theory Page 61 of 68  NURSING CARE OF MR. RENATO H. WITH BETTY NEUMAN'S SYSTEMS MODEL Betty Neuman: The System Model Theory Page 62 of 68  Case History of Mr. Renato H. Mr. Renato H. is an 86-year-old who has been a widower for the past 2 years. He is from San Fernando, Pampanga. He completed his high school and worked in the Armed Forces of the Philippines (AFP) as a soldier until he retired at the age of 65 years. He receives his monthly pension from the government. He is Philhealth Insurance holder as a senior citizen (as provided by law under Pres. Duterte sincumbency). Mr. H. sporadically attends a nearby Catholic parish. He has a married daughter who lives with him in his home. He has a medical history of chronic obstructive pulmonary disease (COPD), gout, hypertension and congestive heart failure. He smoked one pack of cigarettes a day until 8 years ago when he decided to quit smoking because of medical diagnosis of COPD. He had 3 hospital admissions for severe difficulty of breathing in the past two months. He dislikes taking medications but does take a prescribed antihypertensive and diuretic. He also periodically receives bronchodilator nebulization for difficulty of breathing. Betty Neuman: The System Model Theory Page 63 of 68  Case History of Mr. Renato H. Mr. H. was admitted to the hospital for severe shortness of breath. He had vague aches and pains in the chest. He had these symptoms for approximately 10 hours and he was prompted by his daughter to go to the hospital. He was diagnosed to have acute exacerbation with his COPD. He was found to have right-sided congestive heart failure, which explains why he also has edema in both legs. He mentioned to Nurse Charles that he has "loss of appetite to eat, extreme difficulty of swallowing since few months ago." He had evidently lost weight and appears weak and pale. He used to drive for himself before, but had been unable to do since 3 years ago. He had visits from his children and other relatives. His chest x-ray shows cardiac enlargement and pulmonary atelectasis and infiltrates. His cardiac status remains reasonably stable. The physician prescribes ABG analysis and other blood works. His potassium level is low. The physician ordered for oxygen therapy, medications for his COPD, and Ensure for his nourishment. He does not want any tubes inserted into his throat. He wishes to see his sisters. And that he expects to go home in a few days. His dyspnea has greatly decreased and his oxygen saturation is stable. He also admits that he does not want to die in the hospital. Betty Neuman: The System Model Theory Page 64 of 68  Nursing Care of Mr. Renato H. with Betty Neuman's Systems Model Model Components and Application to the Case History of Mr. Renato H. 1. Nurse - client relationship A mutual partnership has been developed during initial and ongoing assessment. The nurse perceives the physiological stressor as a priority to prevent further energy depletion but also recognizes the effects of other stressors on the patient's status — psychological, developmental, socio-cultural and spiritual stressors. 2. Physiological Stressors Intrapersonal: COPD, Congestive Heart Failure, Hypertension, Dyspnea, Edema, Chest X-ray Pathology, New Medications, Difficulty in swallowing. Interpersonal: states he had lost appetite to eat and food is "tasteless" Extrapersonal: Effect of situational stress (illness, current fears, future concerns, discharge) on physiological system. 3. Psychological Stressors Intrapersonal: fear of tubes, fear of death in the hospital, lifestyle changes, states he wants to go home. Interpersonal: asks for his sisters, possible dysfunctional grieving for loss of wife. Extrapersonal: physical separation from support systems while hospitalized. Betty Neuman: The System Model Theory Page 65 of 68  Nursing Care of Mr. Renato H. with Betty Neuman's Systems Model Model Components and Application to the Case History of Mr. Renato H. 4. Developmental Stressors Intrapersonal: 86 years old, high school graduate, needs basic explanation on what is happening to him, asks if he is going to die. Interpersonal: widower of 2 years, 5 married adult children, ego integrity vs. despair issues. Extrapersonal: possible loss of autonomy in relationships. 5. Sociocultural Stressors Intrapersonal: retired AFP military man. Interpersonal: frequent interaction with daughter who takes good care of him. Extrapersonal: fixed pension from the government, Philhealth, lives in his home with daughter and her family, unable to drive for himself since 3 years ago. 6. Spiritual Stressors Intrapersonal: Finds meaning in belonging to a church, speaks of god and prayer. Interpersonal: Not active in local parish, wishes to attend church more regularly, but feels weak and ill to do so. Extrapersonal: Unknown life - death situation Betty Neuman: The System Model Theory Page 66 of 68  7. Affected Boundaries Mr. Hipolito's flexible and normal line of defense have been penetrated, and his lines of resistance have been activated. If prevention interventions are not effective, system disequilibrium will cause death. Thus, secondary interventions will be implemented to strengthen his lines of resistance and tertiary interventions will be implemented to strengthen his flexible line of defense. Betty Neuman: The System Model Theory Page 67 of 68  THANK YOU Betty Neuman: The System Model Theory Page 68 of 68