The Neuman System Model uses a systems approach that is focused on the human needs of protection or relief from stress (Neuman & Fawcett, 2009). Neuman believed that the causes of stress can be identified and remedied through nursing interventions. She emphasized the need of humans for dynamic balance that the nurse can provide through identification of problems, mutually agreeing on goals, and using the concept of prevention as intervention. Neuman’s model is one of only a few considered prescriptive in nature. The model is universal, abstract, and applicable for individuals from many cultures (Neuman, 1995; Neuman & Fawcett, 2009). Neuman used concepts and theories from a number of disciplines in the development of her theory. In her works, she referred to Chardin and Cornu on wholeness in systems, von Bertalanfy and Lazlo on general systems theory, Selye on stress theory, and Lazarus on stress and coping (Neuman, 1995; Neuman & Fawcett, 2009).
In her work, she defined human beings as a “client/client system, as a composite of variables … physiological, psychological, sociocultural, developmental, and spiritual (Neuman & Fawcett, 2009, p. 16). Environment in the model represents the three environments, internal, external, and created environments, which influences the client’s adaptation to stressors. Neuman’s System Model in the nursing realm, is to maintain client system stability through accurately assessing environmental and other stressors and assisting in client adjustments to maintain optimal wellness. Neuman model consisted of a three-step nursing process model in which nursing diagnosis (the first step), nursing goals as determined with the client and family (the second step), and lastly, nursing outcomes that confirm and evaluate the client’s healthcare goals. I have always look at the total picture when encountering individuals from a personal standpoint, professionally in the clinical setting, and in the community to address issues that constitutes the total person outside of the health/illness continuum.
Neuman’s System Care Model can be used in a practical setting where I work on the stepdown unit.While caring for a 67 yr old AA male who was post-op day1 prostatectomy with a hx of hypertension, diabetes, colon cancer, TIA, anxiety, and depression became symptomatic during shift change. The patient’s family called to the nurse’s station because he became weak and unable to ambulate back to his bed. Upon arriving to the patient’s room I found him sitting on the commode with c/o nausea and vomiting which is common after this type of surgery. With further assessment, I noted the client became diaphoretic and dizzy while attempting to stand. Vitals were stable at this time but I my intuition told me that something just wasn’t right.First thing that came to mind was that the pt vasovagal while trying to have a bowel movement. The Scip protocol was in place at this time, IV fluids infusing, foley in place with adequate urinary output noted, telemetry on with no ectopy noted. I told the family to call the nurse’s station to bring a wheelchair to the room to assist with transferring the pt back to bed. The patient had expressed to me that he was under a lot of stress due to the lost of his mother, his second bout with cancer, and the financial strain he was under for being out of work for his health conditions. While attempting to place the patient in the bed he had another diaphoretic episode with generalized weakness. My intuition lead me to believe this patient was having an MI. I took an additional set of vitals, revisited the lab work, placed the pt on oxygen at 2 liter, and ordered a stat EKG. I viewed the EKG and noted an elevated ST segment and paged the cardiologist on call; while simultaneously informing the house supervisor of my findings. Within 10 minutes or less the client was in route to the cath lab for stent placement.
Re examining Neuman’s System Model, I was able to utilize the three step nursing process to 1.) identifying a nursing diagnoses that includes but not limited to: risk for decreased cardiac output, anxiety, activity intolerance, ineffective coping, risk for falls, nausea, and imbalanced nutrition just to name a few. 2.) Establishing patient/family centered goals that constitutes their beliefs, values,and customs such optimizing cardiac output with stent placement, ensuring the client is hemodynamically stable, addressing nutritional status with the interdisciplinary team to ensue dietary requirements are met, providing counseling to assist with helping the client cope with his loses that internally and externally precipitated stress. 3.) Evaluation and clarification of the client’s outcomes. The patient underwent angioplasty with stent placement and was transferred to the ICU without incident. Neuman’s model allowed me to assess the patient from a holistic point of view that lead to favorable outcomes. The physicians, house supervisor, and staff was so impressed with my knowledge and skills that I received the Daisy’s Award for exceptional nurses that year.
To this present day, that patient stills comes to the facility I work at to thank me for saving his life. Often healthcare professional become overwhelmed with the everyday task of the discipline that little signs such as nausea/vomiting goes unnoticed. The patient did not complain of pain at anytime during the assessment. Neuman’s model can be used in any nursing setting because it directly ties the patient to the nurse and the environment that are in constant motion either propelling towards health, where energy is conserved or towards illness that depletes the storage of energy. The clinical and critical skills I’ve acquired and taking an holistic approach while caring for patients and families allowed me to be present with the patient and family thus addressing his healthcare needs while optimizing his overall quality of health.
References:
McEwen, M. (2014). Theoretical Basis for Nursing, 4th Edition. [VitalSource Bookshelf version]. Retrieved from http://online.vitalsource.com/books/9781469899992
Neuman B, Fawcett J. The Neuman Systems Model. 5th ed. Upper Saddle River, NJ: Prentice Hall; 2010.
