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Nursing theories are brought about organically as nurses set forth to provide the highest quality patient centered care possible. As specific nurses over time have cared for their patients, they developed expertise and technique that is of such importance to the nursing profession that it is implemented as a Nursing Theory. The Neuman System Model (NSM) emphasizes its focus on stress and how it is perceived by a patient. Neuman’s model is a grand theory and embodies a holistic approach to patient care.
The system as it is defined by Neuman is an individual, family, or community (Potter, Perry, Stockert, & Hall, 2017). As Alligood and Marriner-Tomey point out, “What is unique to the NSM is that ‘‘each client system is unique, a composite of factors and characteristics within a given range of responses” (as cited in Ahmadi & Sadeghi, 2017, p. 2).
Each individual is said to have a core of basic survival systems and regulation that is protected by lines of defense both physical and behavioral (Ahmadi & Sadeghi, 2017).
The system categorizes stress as interpersonal, intrapersonal, or extra personal (Fawcett & Foust, 2017).
When analyzed, each type of stress has various effects on different patients because each patient perceives stress differently; in addition, the scenarios causing the stress are not often identical in patients. Some patients view certain stressors as beneficial, which can actually strengthen the patient’s core. However, not all stress is beneficial, and when not beneficial to the patient these can compromise the patient’s core (Fawcett & Foust, 2017). These stressors are constantly changing as an individual interacts with the environment, so it is necessary for nurses to pinpoint them. Assessing and identifying stress properly will help the patient obtain a stable line of defense of illness (Potter et al., 2017).
Every patient deals with a number of stressors at any given point in time, so focusing nursing intervention on the proper stressor at the right time is key in practice. Whether in a hospital, nursing home, rehabilitation, or urgent care, nurses are the front line of defense for very ill patients and thus can turn the patient outcome for the better or worse depending on quality of nursing practice. Thus, identifying these stressors accurately is instrumental to ensuring positive health outcomes to meet patient needs. Just as when a health care provider is prescribing medication, the provider needs to be sure that this will be the medication that the patient needs to subdue their symptoms. A nurse needs to be sure what the source of the stress is to ensure proper nursing therapies to bring back balance in the patient. The NSM uses a systems approach which takes into account the response to stress by an individual, family or community. This encompasses the phenomena that a stressor at one place in a system affects many other parts in the system whether that be a community or an individual (Potter et al., 2017).
This system gives a model or a framework for a nurse to be able to assess a patient actively and expose or uncover what is causing stress to the patient and compromising the patient’s core.
The NSM is a very practical tool that the modern-day nurse can use in providing optimal care for patients today. Neuman’s model approaches patient care from the standpoint that the main goal is to stabilize the patient’s system. It assumes that this can be done by intervening to reduce the stressors that are affecting the patient (Fawcett & Foust, 2017). These stressors can be the physical symptoms that the patient is suffering from, or the lifestyle choices that they have made that have resulted in their physical ailment. The NSM states that there are three levels of intervention to stabilize the patient’s system: primary, secondary, and tertiary (Ahmadi & Sadeghi, 2017).
Nurses in today’s modern society can still use the NSM to provide better healthcare to their patients. They can use primary treatment by showing patients the correct lifestyles they should be living to prevent health problems from arising. They can use secondary treatment by addressing the patient’s medical needs once they have already shown symptoms of their medical problems. They can use tertiary treatment by providing proper exit care to ensure the patient does not return with the same problems.
Betty Neuman’s systems model is a very practical tool that the modern day nurse can use in providing optimal care for patients. Neuman’s model approaches patient care from the standpoint that the main goal is to stabilize the patient’s system. She believes that this can be done by intervening to reduce the stressors that are affecting the patient (Fawcett, 2017). These stressors can be the physical symptoms that the patient is suffering from, or the lifestyle choices that they have made that have resulted in their physical ailment. Neuman states that there are three levels of intervention to stabilize the patient’s system: primary, secondary, and tertiary (Ahmadi, 2017).
The Neuman System is beneficial in the diverse amount of settings in which it can be applied. One important factor is it enables much freedom of methods used when it is being performed and can be applied to many health care settings by many types of nurses especially beneficial in long term settings. One method that has proven unique and beneficial in identifying stressors in older age adults was by categorizing elders ages 60 to 100 into smaller sub groups, young old sub group ages 60 to 74. The older old sub group which consists of ages 75 and 89, and the oldest old which range from 90 to over 100 (Fawcett and Foust 2017). The stressors identified in these groups varied from each group whereas the young old category dealt with different interpersonal stressors such as the oldest old. The Oldest old had seemed to come to identify with the aging process and their bodies changing on a gradual level, where as the young old group was generating stress while learning to accept the challenges of aging. A larger cause of stress on the oldest old group would be loss of a spouse (Fawcett and Foust).
Although the Neuman system is broad in its scope of practice it still has certain criteria that must be implemented to use the system Nurses must accurately identify and classify stressors. Nurses using the Neuman system must also identify how the patient responds to stress, especially noting responses that can be correlated with chronic disease (Fawcett and Foust 2017).
The NSM can be a useful framework in nursing practice; however, it is not without flaws. The model is complex and comprised of numerous interrelated concepts and ideas (Ahmadi & Sadeghi, 2017). Because of the complexity of the model, it can be time consuming to implement. Time and energy are required of nurses in order to successfully put the model into action. This additional input may not always be feasible in hospital environments where nurses often do not have time and energy to spare.
The NSM requires identification and organization of stressors (Fawcett & Foust, 2017). These stressors are qualitative and can be highly personal, so it could be a challenge to identify all of them. Some stressors in the more personal domains could potentially be overlooked. In addition, the nurse relies on the patient and their family to provide information regarding possible stressors. This information must be credible for the nurse to accurately identify stressors (Inan & Ustun, 2016). Patient mistrust of a nurse could lead to them providing false information or omission of important details, which could in turn cause misidentification or omission of stressors by the nurse.
A nurse will likely be able to observe some patient stressors in the physiological domain, but more interaction between the nurse and the patient or their family is needed to identify complex stressors in the psychological, socio-cultural, and spiritual domains (Ahmadi & Sadeghi, 2017). In locations where nurse-patient interaction is short-term or very limited, such as in an emergency department setting, the NSM may not be realistic.
In the literature reviewed for the writing of this paper, multiple peer-reviewed journal articles were evaluated; they all concluded that the NSM can successfully be used as a framework for basing nursing practice (Ahmadi & Sadeghi, 2017; Fawcett & Foust, 2017; Inan & Ustun, 2016).
An essential principle of the NSM is that every patient system is unique (Ahmadi & Sadeghi, 2017). It acknowledges the individuality of every patient and every situation and therefore can be applied for use with practically any kind of patient, in any location or environment, with any health issue. By recognizing patients as unique individuals, it is able to cross possible barriers associated with geography, age, culture, and diagnosis. It has been successfully applied in Turkey with breast cancer survivors (Inan & Ustun, 2016), in Iran with patients who have multiple sclerosis (Ahmadi & Sadeghi, 2017), and globally with aging populations (Fawcett & Foust, 2017), just to name a few. The NSM can be successfully applied for patients who are relatively healthy, as well as ones with multiple comorbidities (Fawcett & Foust, 2017).
The NSM has been shown to have a positive impact on patient care; Fawcett and Foust (2017) go as far to conclude that it is “an ideal guide for comprehensive geriatric assessment of stressors” (p. 271). In addition to improving the quality of care, use of the NSM also increases patient satisfaction (Ahmadi & Sadeghi, 2017). The model emphasizes collaboration between the nurse and patient through all stages of the nursing process, which leads to positive outcomes (Ahmadi & Sadeghi, 2017).
The NSM can also be applied to health care workers themselves (Turner & Kaylor, 2015). It provides a comprehensive framework that can aid in the prevention of and recovery from adverse health effects in patients and the nurses who care for them (Turner & Kaylor, 2015). The NSM can be applied across countless demographics to promote optimal outcomes for patient and caregiver health (Fawcett & Foust, 2017).
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