N112 Neuman Systems Model Spring 2024 PDF

1 Neuman Systems Model Beverly McLawyer, MSN, RN Los Angeles County College of Nursing & Allied Health N112 Professional Role [email protected] 1 1 2 Objectives After this presentation, student will be able to: discuss the purpose of a conceptual framework in nursing practice and educatio...

1 Neuman Systems Model Beverly McLawyer, MSN, RN Los Angeles County College of Nursing & Allied Health N112 Professional Role [email protected] 1 1 2 Objectives After this presentation, student will be able to: discuss the purpose of a conceptual framework in nursing practice and education explain the principles of system’s theory summarize the holistic dynamics of the client as defined in the Neuman Systems Model. 2 3 Definition of Terms Nursing model Conceptual framework Nursing theory 3 1 2 4 A Nursing Model – a set of abstract & general ideas, concepts or statements – serves to provide a framework for organizing ideas about clients, environment, health & nursing 4 Nursing Metaparadigms A set of concepts and propositions that sets forth the phenomena with which a discipline is concerned. The most general statement of a discipline Concepts that identify the phenomena of central interest to a discipline 5 6 2 3 7 Conceptual framework - a group of related ideas (concepts) that follows an understandable pattern Also referred to as conceptual model Blueprint Instructions More loosely structured than nursing theories 7 8 9 Common Characteristics of Nursing Theories Controls Predicts Desired Outcomes of Nursing Practice Explains Describes Nursing Theory 9 3 4 10 Nursing Theory Logical in nature Orderly reasoning Describes relationships Logical sequencing 10 11 Role of Nursing Theory Education Research Nursing Practice 11 12 Role of Nursing Theory in Research Identifies: Generates: philosophical assumptions conceptual framework previous assumptions gaps/problems new ideas research questions interpretations 12 4 5 13 Role of Nursing Theory in Nursing Practice Nursing theory in clinical practice Reflecting, Questioning, & Thinking about what nurses do Facilitates: Contributes to evidence-based practice Encourages the nursing profession to change the focus from individuals to families and social structures 13 14 Role of Nursing Theory in Education Identifies major concepts Organizes the concepts into a conceptual framework to establish an entire curriculum Language from models are found in: Program objectives Course objectives & descriptions Clinical performance criteria 14 15 Systems Theory 15 5 6 16 Components of a System Fundamental components of a system necessary for a system to exist are: Matter Energy Communication 16 17 General Systems Theory System Theoryall parts of the system are interrelated – A change in one part will influence another part 17 18 Open System Open systeminteraction with environment – All living things (plants, animals, people, etc.) – Maintain balance via feedback for survival 18 6 7 19 Open System Allows free movement of energy, matter, & information between subsystems and boundaries – Input- factors entering the system – Throughput- how input is utilized by the system – Output- what is transferred out to the environment 19 20 Closed System Closed system- no interaction with environment – Chemical reaction in a test tube – Do not exist outside of the lab 20 21 A Nursing Theory Used in Nursing Practice: Betty Neuman Systems Theory 21 7 8 22 Betty Neuman, Ph.D., RN Recognized as a pioneer in the field of nursing in community mental health 1970- developed her Neuman Systems Model – Based on an individual’s relationship to stress – A way to teach an introductory nursing course After a 2-year evaluation, her model was finally published in Nursing Research 22 23 23 24 Neuman Systems Model Based Incorporates Conceptualizes Theory includes: on a client’s constant relationship & response to stress a wholistic concept & open-systems approach health as a continuum from wellness to illness to death Client (person, family, group, & community) Health Environment Nursing Prevention as intervention 24 8 9 25 Neuman Systems Model Man: Environment: An open system Both internal and external Neuman Systems Model Health: Nursing: concerned with prevention System stability 25 26 Client Recipient of care: Person Family Group Community Requires individualized care Degree of reaction/response differs 26 27 Five Client Variables Physical/ physiological Sociocultural Psychological Spiritual Developmental 27 9 10 28 Physical/Physiological Variable Bodily structure & function 28 29 Psychological Variable Mental processes & relationships 29 30 Sociocultural Variable Social & cultural expectations & activities 30 10 11 31 Developmental Variable Age-related developmental processes & activities 31 32 Spiritual Variable Spiritual beliefs & influences Relating to or affecting the human spirit 32 33 Environment All internal & external factors/influences surrounding the identified client/client system. Internal Created external 33 11 12 34 Environment The Internal Environment – Consists of all forces or interactive influences internal to or contained solely within the boundaries of the defined client/client system. It is INTRAPERSONAL The external environment – Consists of all forces, interactions, or influences external to or existing outside of the defined client/client system. It is INTERPERSONAL & EXTRAPERSONAL. 34 35 Environment The created environment – Unconsciously developed by the client as a “symbolic expression of system wholeness,” It is INTRAPERSONAL, INTERPERSONAL, & EXTRAPERSONAL. – Supersedes & encompasses both internal & external environment. – Acts as an immediate or long-range ‘safe’ reservoir for existence, or the maintenance of system integrity – Unconsciously developed, since its function is to offer a protective shield or safe arena for system function 35 36 Stressors Stressors: ~Tension-producing stimuli/forces on the environment. ~Classified as: ~Intrapersonal ~Interpersonal ~Extrapersonal 36 12 13 37 Intrapersonal Stressors – Inside (within) the client/client system – Example: Infection, medical or psychological dx Fx Stable HgbA1C T2DM NV COPD BIPOLAR DISORDER PNA 37 38 Interpersonal Stressors Outside the client/client system but in close proximity (between one or more) – Example: Role expectations 38 39 Extrapersonal Stressors Outside the client/client system at distal range – Example: Financial concerns 39 13 14 40 Client System 40 41 Diagram of the Client System Client is the basic structure (core) that is surrounded by: – Flexible line of defense – Normal line of defense – Lines of resistance 41 42 Flexible Line of Defense Outer boundary of the client system Prevents stressor invasion Protects the normal line of defense “Flexible” in the amount of protection Can be rapidly altered over a short period of time, For example: – Coping patterns – Lifestyle factors – Developmental factors 42 14 15 43 Normal Line of Defense Usual level of health/wellness Responds and changes according to coping or the environment Influencing factors: – Coping patterns – Lifestyle factors – Developmental factors – Spiritual influences – Cultural considerations 43 44 Lines of Resistance Protective mechanism Attempt to stabilize the client system and return to the usual wellness level Support the normal defense line – Mobilize WBCs – Activate immune system 44 Immediate activation of the flexible line of Response to defense Stressor(s) If ineffective, the normal line of defense is penetrated (client illness) Lines of resistance are activated when the stressor invades the normal line of defense Effective lines of resistance = reconstitution Ineffective lines of resistance = death 45 45 15 16 46 Health = System Stability (Illness vs. Reconstitution) Illness: – State of insufficiency – Excess expenditure of energy Reconstitution: – Identified as the beginning part after treatment – State of adjustment to stressors – Optimal use of existing resources for client system stability *Death will occur without reconstitution* 46 47 Nursing Major concern is keeping the client system stable through: – Assessing the effects & possible effects of environmental stressors – Assisting client adjustments required for optimal wellness (health) Nursing actions are initiated to retain, attain, & maintain optimal client health Concept of “Prevention as Intervention” 47 48 3 Levels of Prevention Primary Tertiary Secondary 48 16 17 49 Primary Prevention Protecting the normal line of defense Strengthening the flexible line of defense Identification of actual or potential risk factors Begins at any point if a stressor is suspected or identified Goal is to promote client wellness by: – Stress prevention – Reduction of risk factors – Reduce the possibility of stressor encounter(s) 49 50 Secondary Prevention Strengthening internal lines of resistance Reducing the reaction Increasing resistance factors Based on symptoms after a reaction to a stressor Provided when primary prevention was not provided or failed Begins at any point after symptoms present Goal is to provide treatment of symptoms to attain client system stability 50 51 Tertiary Prevention Tertiary Prevention: – Re-adaptation & stability – Protects reconstitution or return to wellness Occur after secondary preventions are implemented Begins at any point in client reconstitution following treatment Goal is to maintain optimal health by: – Supporting existing strengths – Conserving client system energy 51 17 18 Neuman Nursing Process 52 GOALS (Shared) DIAGNOSIS Requires consideration of both the client’s and the caregiver’s perceptions OUTCOMES Goal (shared): ~Should enable the client Interventions: ~Three dimensions of prevention as interventions ~Implement the plan using interventions: Primary Secondary Tertiary ~Evaluate Is balance restored? Is a stable state of the client system maintained? Used alone or in combination ~Based on client’s health 52 53 Comparison Nursing Process Neuman Nursing Process 1. 2. 3. 4. 5. 1. Nursing diagnosis 2. Nursing goals (shared) 3. Nursing outcomes Assessment Analysis Planning Implementation Evaluation analysis 53 53 Nursing Process Utilizing Neuman Systems Model 54 DIAGNOSIS Assessment ~Stressors Actual potential Analysis ~Health-seeking behaviors ~Activity intolerance ~Lines of defense characteristics ~Ineffective coping ~Degree of reaction ~Ineffective thermoregulation ~Potential for reconstitution GOALS OUTCOMES Planning (shared) Implementation Goal (shared): ~Keep the client system stable. ~Implement the plan using interventions: Primary Secondary Tertiary Interventions: ~Focus on strengthening lines of defense and resistance. Evaluation ~Evaluate Is balance restored? Is a stable state of the client system maintained? ~Interactions w/environment ~Wellness coping factors 54 18 19 Neuman Systems Model & School of Nursing Curriculum 55 55 56 Curriculum Threads HORIZONTAL THREADS V E R T I C A L T H R E A D S CLIENT ENVIRONMENT Sem1 Sem2 Sem3 Sem4 HEALTH NURSING 56 57 Vertical Curriculum Threads (Four Nursing Metaparadigms) Client Environment Health Nursing 57 19 20 Horizontal Curriculum Threads (Seven Clinical Core Competencies) 58 Nsg Process / Patient-Centered Care, Safety Collaboration / Teamwork and Collaboration Accountability / Quality Improvement Communication / Nursing Informatics Education / Evidence-Based Practice Decision Making / Teamwork and Collaboration Sociocultural Sensitivity / Patient-centered Care Note: built into the core competencies is Professionalism 58 59 Sem1 Sem2 Nursing Sem3 Nursing Sem4 Nursing Nursing Process Collaboration Accountability Client Communication Education Decision Making Environment Sociocultural Sensitivity Nursing Process Collaboration Accountability Client Communication Education Decision Making Environment Sociocultural Nursing Process Collaboration Accountability Client Communication Education Decision Making Environment Sociocultural Nursing Process Collaboration Accountability Client Communication Education Decision Making Environment Sociocultural Sensitivity Sensitivity Sensitivity Health Health Health Nursing Health 59 60 60 20 21 61 61 62 References Berman, A., Snyder, S., & Kozier, B. (2016). Kozier & Erb’s Fundamentals of nursing: Concepts, process, and practice. (10th ed.). New Jersey: Prentice-Hall, Inc. Farlex Partner Medical Dictionary. (2012). Retrieved May 2 2019 from https://medical-dictionary.thefreedictionary.com/nursing+model Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. (2nd ed.). Philadelphia: F.A. Davis Company http://nursingtheories.blogspot.com/2008/07/betty-neumans.html Neuman, B. (1989). The Neuman systems model. (2nd ed.). New Jersey: Prentice-Hall. Taylor, C., Lynn, P., Bartlett, J.L. (2019). Fundamentals of nursing: The art and science of person-centered nursing care (9th ed.). Philadelphia: Wolters Kluwer. 62 63 Questions??? 63 21