The Neuman Systems model was initiated by Betty Neuman as a framework for nursing care, examining clients as a combination of varying components interacting with the world at large as experienced through different stressors in the environment. Clients are defined as individuals as well as the support systems and communities that create a unit. Stressors and environments exist in forms of different sizes and impact the client in a multitude of levels. This model has helped to shape modern nursing practice and research and will continue to be a beneficial structure for the future of healthcare.
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The Betty Neuman Systems model examines the patient, or client, as a complex multifaceted entity. This is based on a general system theory, where living organisms are considered open systems integrating with each other and the environment (Ahmadi & Sadeghi, 2017). The term ‘client’ can be an individual, but also can be defined as a family, group, or community. Client systems are broken down into five variables: physiological, psychosocial, sociocultural, spiritual, and developmental. Physiological refers to the basic body structure and function of the client’s physical health. Psychological, as the name suggests, is the client’s mental health and their mental processes relative to their environment. Sociocultural deals with the social and cultural conditions in a client system, and how it effects their decisions, particularly as it relates to health care choices. Similarly, spiritual encapsulates belief systems and the influence on the client. Developmental relates to the client’s age and changes in processes and activities through the lifetime.
As a unit, the client exists as a ‘core’, protected by two lines of defense. The first line, or the outer layer, is viewed as a flexible line of defense, the first to respond to stressors. The more developed the line of defense, the greater the protection of the client core (Turner & Kaylor, 2015). The second, inner line of defense ideally remains stable. It represents the state of wellness and adaptation of the client system. Stressors can come in three forms, intrapersonal, interpersonal, or extrapersonal. Intrapersonal stressors are those that exist within the client that shape the conditioned responses to the world. Interpersonal is the stressor that arises with the interaction of two or more people, such as role expectations and the responsibilities that come with relationships between family and friends. Extrapersonal refers to factors that impact the client that are unrelated to the client’s personal system, such as finances. These stressors can affect the client in all the aforementioned variables in the client system.
Treatment for these stressors are classified into three levels: primary, secondary, and tertiary prevention. Primary prevention occurs even before stressors are encountered. Interventions at this level serve to strengthen a client’s flexible outer line of defense and to protect the stable inner line of defense (Angosta, Ceria-Ulep, & Tse, 2014). This can be through means of assessment, health promotion, and educational programs to prevent or reduce a client’s reaction to stress. Secondary prevention strengthens lines of resistance, meaning that after the stressor reaches the client, these interventions protect the client’s core to minimize the damage to the system. Tertiary prevention works to return the client system to an optimal state of wellness. This could include reflection and evaluation of the stressor and the client response to identify what went well and how to improve the course of action in the future, or it could be a situation where the client needs to learn to adapt to the new irreparable changes the stressors have created, depending on how the event unfolds. Stressors are unavoidable in life, but how a client system responds can vary.
Ideally when a client encounters a stressor, primary interventions had strengthened the outer line of defense enough for the client to remain unaffected. A simple example most associate with this is physiological, such as vaccines that create immunity, so the client does not contract the full strength disease. However, primary interventions can occur in other variables as is the case with a close family, friend, or community system, creating a support system for the client. Healthy interpersonal relationships can create channels for the client to share or discuss their stressors before it can impact their systems. Once a stressor impacts a client, however, it does not always mean it will result negatively. If a stressor does alter a client’s line of defense, hopefully they can learn from the experience and become a stronger unit for it. This involves healthy coping mechanisms in the secondary intervention period. For example, if a client experiences a mental health crisis and then seeks a therapist for psychological help, they are working to resolve the current situation as well as strengthening themselves on the psychological variable for future stressors. Additionally, stressors do not always have to be undesirable conditions. It can be milestones and other life events as innocuous as graduating from school, moving away from home for the first time, getting married, or having children. Regardless of the stressor, it is important to employ coping mechanisms that benefit the client system. If the client responds to stressors with maladaptive behaviors or negative coping mechanisms, it can result in a damaged core. This translates as severe health consequences such as depression, spiritual abandonment, developmental delays, or even death (Turner & Kaylor, 2015).
Overall, Betty Neuman designed the Systems Theory as a holistic approach to patient care. In this model, health is uniquely defined as a continuum from wellness to illness, dynamic in nature and constantly changing (Ahmadi & Sadeghi, 2017). On one end of the spectrum, optimal wellness exists as a state where all system needs are completely met. On the other end is illness, where it is the inverse definition of wellness. System dynamics are unstable, which depletes the energy of the client. The primary aim of nursing is to restore and maintain the stability of a client system. The major concern is to keep clients stable by accurately assessing the effects of environmental stressors and to help clients attain optimal wellness (Angosta, Ceria-Ulep, & Tse, 2014). In modern health care practice, this is evident in the nursing process with nursing diagnoses, goals, and outcomes. Nursing diagnoses differ from medical diagnoses in that the nurse identifies problems, real and potential, in all aspects of a client system, not just physiological. In this method, it is important to involve the client and their caregivers as part of the decision-making process, setting realistic goals and recommending appropriate interventions all parties agree on. Nurses in the hospital setting encounter this as a common list set by the North American Diagnosis Association (NANDA). Collaboration with clients as part of the health care team holds patients accountable for their health care plans and decisions and improves the likelihood that clients comply with lifestyle modifications if or when necessary.
Even today, researchers continue to use the Betty Neuman Systems model in their studies of various communities and other client groups. From the Rafsanjan University of Medical Sciences in Iran, patients with multiple sclerosis were examined. Authors of the paper created nursing diagnoses for the population and listed recommended interventions sorted by appropriate levels of prevention with consideration of unique cultural practices (Ahmadi & Sadeghi, 2017). Similarly, the systems model was used to structure research conducted to analyze Filipino-Americans at risk of coronary heart disease (CHD). Risk factors included not only physiological components but also psychosocial and other lifestyle features, echoing the five variables of a client system as outlined by the Betty Neuman Systems model (Angosta, Ceria-Ulep, & Tse, 2014). In the University of the West Indies School of Nursing, a paper was published to the International Journal of Healthcare on the experiences of Jamaican hospital patients with delayed wound healing (Ekpo, Duff, Bailey, & Lindo, 2015). The Neuman model was used to consider patients on the various interrelated systems of a client. This study also incorporated feedback from the participants, reporting interactions and interventions they would like to receive from health care providers and their care team. This collaboration is a component of the Betty Neuman Systems model, making patients a member of their health care team and accountable for their health. Professors in Bogota, Columbia applied the Systems model to assess the incidence of delirium in intensive care units. The researchers followed the model to identify interpersonal, intrapersonal, and external stressors that could impact the client system (Gómez Tovar, Diaz Suarez, & Cortés Muñoz, 2016). They also created a plan to use interventions at the primary prevention level to strengthen the clients’ lines of defense to prevent the incidence of delirium as a side effect of the stressful environment of the intensive care unit. In the journal Nursing Science Quarterly, assistant professors from the Capstone College of Nursing even took the unique approach to examine nurses themselves as a patient population, using the Betty Neuman Systems model as a framework for their research (Turner & Kaylor, 2015). The article proposed evidence-based approaches to nurse strengthening and resilience, describing the numerous stressors nurses encounter as part of the profession and workplace interventions that can be implemented to support the nurse as a client system. Suggestions included improving dynamics between health care staff, encouraging open communication as well as praise and positive professional relationships. As recommended through the Betty Neuman Systems model, it is important for nurses to develop strong support systems personally and professionally, as well as to practice self-care interventions to enhance coping mechanisms to diminish emotional exhaustion and burnout.
The Betty Neuman Systems model is incorporated in everyday nursing practice and research. Nurses in direct patient care use the systems model even if they do not know it when they identify nursing diagnoses, set goals, and evaluate outcomes of their interventions among the various components of a client and their sources of support at different levels of prevention. Balancing a patient’s comorbidities or conditions beyond simple physiological factors treats clients holistically as a complex system which is a key point of the Betty Neuman Systems model. In research, a ‘client’ can be defined as an individual, a family, or any combination of a community or population. The Betty Neuman Systems model revolutionized nursing theory to treat patients and clients as multifaceted entities and to use interventions addressing treatment at all stages on the wellness-illness continuum. This structure has and will continue to be a foundational framework for health care practice and research.
References
Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal – Experimental, Translational and Clinical, 3(3). doi: 10.1177/2055217317726798
Angosta, A., Ceria-Ulep, C., & Tse, A. (2014). Care Delivery for Filipino Americans Using the Neuman Systems Model. Nursing Science Quarterly, 27(2), 142-148. doi: 10.1177/0894318414522605
Ekpo, C., Duff, E., Bailey, E., & Lindo, J. (2015). Lived experiences of Jamaican hospital patients with delayed wound healing. International Journal Of Healthcare, 2(1). doi: 10.5430/ijh.v2n1p21
Gómez Tovar, L., Diaz Suarez, L., & Cortés Muñoz, F. (2016). Evidence -and Betty Neuman’s model- based nursing care to prevent delirium in the intensive care unit. Enfermería Globa, 15(1), 49-63. Retrieved from http://www.redalyc.org/articulo.oa?id=365843467004
Turner, S., & Kaylor, S. (2015). Neuman Systems Model as a Conceptual Framework for Nurse Resilience. Nursing Science Quarterly, 28(3), 213-217. doi: 10.1177/0894318415585620
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