TERM PAPER INVESTIGATION AND APPLICATION OF NURSING THEORIES AND CONCEPTS TO PROFESIONAL NURSING PRACTICE
Introduction
Neuman developed her nursing model while teaching community mental health at the University of California in Los Angeles during the late 1960s, in response to her students’ need to have an overview of nursing prior to learning specifics (2006). Her model was chosen for this paper because it presents a systems-based framework for viewing individuals, families or communities, and tackles several concepts, such as stress, adaptation, homeostasis, levels of prevention, intra, inter and extra personal factors, optimal wellness and basic structure ( 2000), which are all relevant concepts in everyday situations. With the importance of the concepts underlying the Neuman Healthcare Systems Model, it is important to investigate and summarize this model and its related concepts describing its theoretical basis for nursing practice, and to demonstrate the results of the investigation by applying the findings within nursing practice settings.
Part 1
The Neuman Systems Model was originally developed in 1970 at the University of California in Los Angeles, by Neuman as a way to teach an introductory nursing course to nursing students. The goal of this model was to provide a wholistic overview of the physiological, psychological, sociocultural, and developmental aspects of human beings (2000). The theory of Neuman is a conceptual framework, a visual representation, for thinking about humans and nurses and their interactions, and views the person as a layered, multidimensional whole that is in constant dynamic interaction with the environment, with the layers representing the various levels of defense protecting the core being. There are two major components in the model, namely, stress reactions and systemic feedback loops. Clients or patients react to stress with lines of defense and resistance, while continuous feedback loops fine-tune the lines of defense and resistance to achieve maximum level of stability. In addition, the client is in continuous and dynamic interaction with the environment, so the exchanges between the environment and the patient is reciprocal to achieve optimal system stability and balance. Prevention is the main nursing intervention to achieve this balance, having three activities, namely, primary, secondary, and tertiary, which are used to attain, retain, and maintain system balance (2000).
The Neuman Healthcare Systems Model views the person, health, nursing and the environment in relation to the metaparadigm of the discipline of nursing. It views the person as containing a basic core, surrounded by lines of resistance, encapsulated by a normal line of defense and finally surrounded by a flexible line of defense, and is represented by concentric rings, which surround the basic core structure of the person. In addition, the person or the client system is made of an inner core, which is described as an open and dynamic system that is constantly interacting with both the internal and external environments. Surrounding this inner core are the lines of resistance, which is the usual wellness state, containing certain baseline features and characteristics, such as the client’s coping abilities, cognitive abilities, and genetic constitution. The normal line of defense represents what the client has become, and the state to which the client has evolved over time, or the usual wellness level, while the flexible lines of defense surround the normal line of defense, and ideally prevents stressor invasions of the client system, keeping the system free from stressor reactions or symptomatology (2006).
The model views health as being on a continuum ranging from wellness to illness, and is equated with optimal system stability, that is the best possible wellness state at any given time. In addition, health is viewed as a manifestation of living energy available to preserve and enhance system integrity, where health and illness can be represented on a continuum, where the client system is open and in constant interaction with the internal and external environments (2006). Moreover, the model views nursing as being primarily concerned with maintaining the client system stable, through assessment of the actual and potential effects of environmental stressors on the client system. The system stability is maintained by assisting clients with any adjustments required to achieve optimal levels of health or wellness, in accordance to the belief that nursing assists in achieving and maintaining client system stability through various levels of prevention, having three levels. Primary prevention or health promotion, is used for primary prevention of illness as the basis for wellness, and is used to protect the client systems normal line of defense by strengthening the flexible line of defense, by prevention of system stress and reduction of risk factors. Secondary prevention is used when there has been penetration of the client’s normal line of defense, and prevention is geared towards health attainment by treatment of symptoms in an effort to obtain client stability and to conserve energy of the client system. Lastly, the tertiary prevention is used for maintenance of system stability, and is concerned with regression or maintaining and supporting existing strengths and conserving energy within the client system (2006).
Furthermore, the environment is defined as all internal and external factors or influences surrounding the identified client or client system, and can be influenced by a client positively or negatively at any given point in time. The environment is classified as being either internal, external or created, and the dynamic interaction between the client system and the environment will produce outcomes, which will be either corrective or regulative for the overall client system. The internal environment consists of all forces or interactive influences internal to or contained solely within the boundaries of the defined client or client system; the external environment consists of all forces or interactive influences external to or existing outside the defined client or client system; and the created environment is a representation of the client’s mobilization of the system variables, which are being the physiological, psychological, socio-cultural, developmental and the spiritual, which goes beyond the internal and external environments, encompassing both ( 2006).
In relation to the Neuman Healthcare System Model, several works or studies have already been done, using the model as the basis of their arguments and findings. One of the many works related to this model is the study done by (2006) evaluating the problems identified by student nurses during postpartum home visits, and whether interventions utilized by student nurses during postpartum home visits were consistent with interventions recommended in the postpartum literature. The Neuman Healthcare Systems Model provided the framework for this study for this model incorporates a total person approach to patient problems and conceptualizes health on a continuum dependent upon equilibrium of the state of the system (2006). Results of the study suggest that the student nurses identified problems in all four areas of the environmental domain, namely, income, sanitation, residence, and neighborhood or workplace safety, and these problems are reflected and consistent with those found in the literature, such as depression, role changes, and care-taking skills. Understanding these problems and concerns allows implementation of the primary, secondary, and tertiary prevention interventions within the environment, psychosocial, physiological, and health related behaviors of the clients, with interventions including health guidance, teaching and counseling, surveillance, and case management. Study results also support research to evaluate postpartum nursing interventions, for the lack of research, verifying effective postpartum interventions for diverse problems makes it difficult for nurses to engage in research-based practice or to develop theory-based models of practice (2006).
Another study is the focus on the interdisciplinary use of the Neuman Systems Model in the practice setting, its application to education, and the use of interdisciplinary teams to facilitate the emergence of holistic client care goals from teams of diverse healthcare specialists ( 2000). Due to the fact that the Neuman model builds on general systems theory with the flexibility, which allows identification of the client as an individual, family, group or community, its use is equally appropriate for an interdisciplinary team in a public health department, for this broad range of adaptability facilitates model implementation in many community settings, which have increasingly become the location of healthcare delivery (2000). In addition, believing that the promotion of an interdisciplinary approach could enhance the quality of services rendered to clients by the helping professions, the researchers addressed the need for a shared conceptual framework with a common language and a structure for organizing client formation, and the Neuman model was chosen because it is a systems model that addresses the interplay of the subsystems within the system as well as their interaction with the environment. The study concludes that the work of interdisciplinary healthcare systems using a wholistic model of care is one of the few healthcare options leading toward increased levels of wellness for all people in all countries (2000).
Part 2
To further understand the Neuman Healthcare Systems Model, it is essential to discuss a relevant example in relation to nursing practice. A relevant case study is the case of Janice, a 34-year-old married woman who has problems regarding their family’s transferring to another state, due to her husband’s job. She is currently on medical leave from her job as a teacher’s assistant, and was referred to an outpatient psychiatric group therapy program in order to gain assistance in dealing with depression and anxiety. Her problems regarding anxiety and depression started when they moved to the Lower Mainland from Ontario, two weeks before school started, and her three children were upset with the move, leaving Janice feeling guilty about the situation. Another stressor is her new job, where she was assigned to work with a child diagnosed with attention deficit hyperactivity disorder or ADHD. She did not agree with the management style of the teacher when dealing with the child, and found it difficult to be assertive in dealing with this teacher, which marked the start of her anxiety attacks and insomnia. Due to this, Janice takes medication to relieve her from her anxiety, but leaves her problematic regarding her insomnia. At present, her goals for group therapy are to learn ways to handle her anxiety without medication, and to learn ways to minimize her depression (2002). In applying Neuman’s model, the initial assessment is to assess stressors, such as her depression and insomnia, being intrapersonal stressors, and the move from one place to the next, being her extra personal stressor. In this model, goals are set in collaboration with the client, so Janice’s goals are reasonable and relevant because they were determined by the client and were deemed by the nurse to be manageable goals in this practice setting (2002).
Interventions were carried out at three levels, with the primary intervention being her referral to an outpatient therapy group. Secondary intervention is crisis intervention, where reaction to stressors is assessed and symptoms are treated. In addition, advising her to take medication in the morning, such as Prozac, and encouraging her to talk about ways to handle her anxiety would be secondary prevention. Tertiary prevention is the focus on the return of the person to wellness, and much of the work the client would do in an outpatient program would be tertiary prevention because it focuses on returning her to wellness. Tertiary prevention includes exploring anxiety triggers and exploring her depression, leading to gaining insight about ways to minimize the occurrence of future depressive episodes, which leads to primary prevention that is directed at intervention before symptoms occur (2002). The final stage is nursing outcomes or reassessment, which could be done weekly in some outpatient programs, and Janice would be asked about her perceived progress towards her goals and she would receive feedback from the nurse, which would lead to changes in her intrapersonal, interpersonal, and extra personal factors that determines the success of the nursing interventions (2002).
Conclusion
Although the applications of the Neuman Healthcare Systems Model are relevant and rational, there are some loopholes present in the model, which becomes its limitation. Its loophole is the fact that the client system is composed of layers, and this model does not delineate what layer is being evaluated and referred to. In addition, some concepts in the model are not specifically defined, which could somehow lead to confusion. However, despite the mentioned loopholes, Neuman’s model is still successful in its application in the nursing practice. Its strength lies on the fact that it encompasses the totality of all human aspects, such as a person’s physiological, psychological, socio-cultural, and developmental aspects. From the discussion of this model, it can be inferred that in assessing the condition of patients, it is best to see the totality of his or her situation to properly and effectively administer treatment. It is also helpful if the treatment and diagnosis will be done with the help of other healthcare professionals, to seek their opinion. It would be essential to apply this model to future researches, for with the use of this model, a wholistic approach regarding treatment and diagnosis can be achieved. This theory is also practical because with its use, healthcare professionals can properly assess the condition of the patient, which saves them the time and effort of committing mistakes and inconsistencies.
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