Betty Newman’s Nursing Theory
The yellow team has selected Betty Neuman’s systems (2010) model nursing theory, in part because this theory applies to a broad range of settings and clients. The system theory is easily adaptable to any scenario or setting, as it focuses on the person and how they are reacting to any given situations or stressors. This theory allows all members of the team to utilize this philosophy in their own practice even when the primary focus within a team may be very different from one another.
The system’s theory was created with the inspirations of Von Bertalanfy’s and Lazlo’s general system theory, Selye’s stress theory, Lararus’s stress and coping; and the philosophical writings of deChardin’s and Cornu’s wholeness system (Betty Neuman Biography, n. d. ). Biography Betty Neuman was born on a farm in Ohio in 1924, her mother a homemaker and father a farmer. Neuman completed her diploma as a registered nurse from People’s Hospital School of Nursing in Akron, Ohio in 1947 (Betty Neuman Biography, n.d. ). Neuman continued her education and ultimately received a Master’s Degree in Mental health from the University of California Los Angeles (UCLA) (Betty Neuman Biography, n. d. ). In the beginning of her nursing career she lived in Los Angeles and worked in a diversity of nursing roles, and some of roles include staff nurse, head nurse, school nurse as well as industrial nurse (Betty Neuman Biography, n. d. ).
While teaching at UCLA her graduate students urged her to develop a course that emphasized breadth rather than depth in relation to the variables in nursing, so she developed a model that extended beyond the medical model and focused on the client as a person not only a diagnosis (Betty Neuman Biography, n. d. ). This theory allowed her to focus nurses on the client, their abilities to deal with stress and pinpoint where a need may be present that the nurse may help address. Betty Neuman continued her nursing theory development and made several revisions to her theory.
Neuman continued to actively participate in teaching as well as serving as a consultant internationally for theory-based practice for nursing schools and she has dedicated her life to the advancement of nursing directing nurses to focus on the person and how to assist them with the needs they are experiencing (Betty Neuman Biography, n. d. ). Neuman’s work provides a framework for nurses worldwide to deliver care to those in need beyond the basic physical needs, addressing psychological, sociocultural, spiritual and developmental aspects of the client (Reyes, Ricana, Rico, Rimas, & Rosales, 2008).
Category Neuman’s (2010) model utilizes a systems methodology that primarily focuses on human needs and defense from stressors (Betty Neuman Biography, n. d. ). According to (McEwen & Wills, 2011), Neuman’s theory falls under grand nursing theories based on human needs; this theory also adheres to the metaparadigm concept and, has led to the development of many other new concepts for her system model. Grand theories provide a conceptual framework where the key perceptions and ideologies of the discipline can be identified (Nursing Theories, 2011). Assumptions
The assumptions used by Neuman to create the systems model are the following: each client has a unique system, and nurses should be concerned with treating the person as a whole, not just one aspect of the individual (Reyes et al. , 2008). An individual is surrounded by many stressors and appropriate responses to stressors are very much individualized (Reyes et al. , 2008). Wellness is also seen as a continuum of available energy which helps the system to achieve optimal stability, and it is the nurse’s responsibility to assist their client to achieve their higher levels of stability through their interventions (Reyes et al., 2008). The nurse-client relationships is seen as collaborative relationships with both sides have an equal responsibility for restoring health, and the client is constantly exchanging energy with the environment (Reyes et al. , 2008). Even though Neuman’s (2010) model is not testable, it has been widely used in nursing practice and education. It gives rise to the hypothesis that can be tested in research. Neuman’s model has been a very important building block, on which the nursing profession developed during the 20th century because it has define a nursing process for nurses to follow.
Concepts and Propositions Betty Neumann’s model was developed with six major concepts and propositions which varies with the individual person, but has to be considered simultaneously and comprehensively. According to (Heyman & Wolfe, 2000), there are six concepts and the first concept is the personal variables, this refers to the fact that every patient is a unique system within itself, which are comprised of physiological, psychological, sociocultural, spiritual, and developmental differences.
The second concept is the central core or basic structure; this is comprised of basic survival factors that are common to the human beings and is based on the patient’s relationship to stress and reaction to it. These factors can include things like genetics, normal temperature range, organ strength or weakness, and the ego structure. Within this concept stability is achieved when the amount of energy that is available exceeds what is being used by the system.
Therefore the dynamic process of input, output, feedback, and compensation must be in alignment in order to maintain the system balance or well-being. The third concept is the line of defense (LOD) which includes a flexible line of defense and a normal line of defense, which are protective mechanisms that protect the body from recognizable, unrecognizable, and universal stressors. Both of these lines of defense can vary from time to time depending on several factors like age, and the type or length of time that a stressor is present.
One example of a LOD would be skin, which is steady and fairly stable, but can increase into a callus throughout time. The fourth concept is the lines of resistance that protect the basic structure and become initiated when environmental stressors attack the normal line of defense. The immune response is an illustration of this concept. The fifth concept is the stressor itself; this is any environmental energy which could possibly affect the balance of the patient.
These stressors have been identified as intrapersonal, interpersonal, and extra-personal; and all of the stressors can upset the system balance and create an environment of illness and disease. The sixth concept is prevention, which is the concentrates of keeping stressors along with the stress response from having a damaging effect on the body. The prevention is accomplished in three levels. At the primary level, patient education and knowledge is the first line of defense with all stressors.
The secondary level focuses on treatment and preventing further comprise to the central core. Lastly the tertiary level relates to adjusting processes taking place as the healing begins, and maintenance factors move them back in a cycle toward primary prevention. Examples in literature Margaret Newman’s health expanding consciousness (HEC) is again described as focusing on the evolution of the whole person despite disease, debilitation, or loss. Health of individuals is possible despite disease (Nursing Theories: An Overview, 2011).
Individuals are capable of acquiring wholeness and “finding greater meaning in life,” as well as connecting with other people on new dimensional levels despite illness, disease, loss and debilitating conditions (Newman, 2010). HEC takes into consideration human pattern in connection with constant changing through time and space while interacting with the environment, developing consciousness of self and evolving through adjustment and change (Nursing Theories: An Overview, 2011).
According to (Musker & Kagan, 2011), the paradigm of Newman’s HEC to a “search for patterns of wholeness” not just identifying the cause of disease, but looking at the full picture of wholeness as it unfolds. (Musker & Kagan, 2011) further takes into consideration “eventual unfolding” is as a result of “higher level of consciousness” and that wholeness is in relation to the process of interaction of person-environment not as separate entities, but includes that of person, community, family, institution, world, etc.
Newman identifies the nurse as helping “people to use the power within to develop the higher level of consciousness. ” (Nursing Theories: An Overview, 2011). (Schuyler, 1992) notes the nurse’s role in recognizing the unfolding pattern of individual’s wholeness as it relates to health and, therefore, the importance of an appropriate and timely response. Review of literature (Wade, 1998, p. 279) states that nursing theory is an under-recognized source of power for nurses and that there is opportunity to become fully educated in the many nursing theories therefore developing nurses into change agents.
With this in mind, a review of literature revealed (Wade, 1998, p. 713) implementation of Newman’s HEC in a concept analysis of “theoretical perspective of personal transformation”. Wade (1998) identified personal transformation as the “’state of being conscious of one’s consciousness’” (Ferguson 1980, p. 68). In relating the concept of personal transformation, Wade (1998) recognized that concept analysis was necessary to link to Newman’s theory of health expanding consciousness (p. 713).
Transformation was identified as change of character and consciousness of how a person viewed the world as well as the individual’s adoption of a “new self-definition, new passion for life and greater sense of power” (Wade, 1998). Wade (1998), via further research of literature, noted that in order for personal transformation to occur, the environment must be reflective to the individual (p. 714). Wade (1998) notes the educator’s ability to influence the transformation of others leaves them also open for transformation.
Pizzi (1990) reflected on how professional transformation played a major role in the personal transformation of individuals. Wade (1998) again in linking the concept of personal transformation to Newman’s HEC theory recognizes self consciousness and understanding human behavior as “parallel to the phases of transformation process” by identifying the evolution of the wholeness. This evolution of wholeness includes individual’s interaction within environment, self consciousness for change from old ways in addition to the relationship developed with nurse, family and community.
Integration into practice Health and Andrews (2006) makes note of the views presented by the Center for Disease Control in which the organization recognizes the major role nursing practice plays in addressing the health disparities of individuals in life threatening, yet preventable, causes of disease. Therefore, according to Newman (2000), “the pattern of the whole is the phenomena of nursing practice” (p. 24). The nurse guided by the HEC theory becomes more in tune with the pattern of wholeness associated with individuals and uses it as an opportunity to promote change.
Musker & Kagan (2011) states that “pattern recognition provides a way of grasping complexities and transforming them into meaningful action” (p. 281). This then becomes relevant in policy making process (Musker & Kagan, 2011). Health & Andrews (2006) notes that changes in nursing practice are usually related to healthcare demands. Thereby, recognizing and addressing situations surrounding health and disease in consideration of the pattern of human wholeness, process of policy making and basic nursing are similar in thatboth require: a) subjective and objective information, b) assessment of situation, c) development and implementation of a plan and d) evaluation of the plan (Musker & Kagan, 2011, p. 282). With this in mind, integrating HEC into practice requires nurses to gain personal transformation by engaging in nonjudgmental care by way of assessment of subjective and objective information (Wade, 1998). This personal transformation of the professional allows for an empowerment of the client in their recognition of “new possibilities through their experiences” (Wade, 1998).
Musker & Kagan (2011) also points out that to integrate HEC into practice, it is important that community stakeholders are mutually aware of the community health problem and the association of the pattern evolution of wholeness. With this in mind, “meaningful transformative changes in society” and the effect on the wholeness pattern of individuals can occur (Musker and Kagan, 2011). Assessment guide Betty Neuman’s theory can be integrated in daily nursing practice in a variety of health care settings.
The yellow group decided to take the disease condition of diabetes as an example. The responsibility of the nurse in Neuman’s 2010 model is to keep the system stable by using three levels of prevention such as primary, secondary and tertiary (Betty Neuman, 2012). According to this model, the nurse must assess the client in regards to physiological, psychological, socio cultural and aspects all of which affect the patient’s physical condition (Jones). The nurse should enquire about the client’s likes and dislikes.
The nurse can perform an assessment to evaluate the knowledge about the disease condition and assess what support the patient has as well as what level of self care the client is able to perform. Thus the nurse can involve the patient in his or her own care and include them in the teaching plan. Teaching Plan Primary prevention starts before the diagnosis. The healthcare provider can educate the patient about the process of disease, complications, and the importance of doing the exercise and controlling the diet. Encourage the client to engage in one of the favorite hobbies together with friends.
The secondary prevention starts in the beginning stage of disease, the nurse can teach how to check the blood glucose level after each meal, the symptoms of hypoglycemia and hyperglycemia, medications and its side effects. By considering the dietary preferences of the client the nurse should teach how important a well-balanced diet is, as well as how to count calories and carbohydrates. Tertiary prevention aims to prevent the serious complications of the disease. Remind the client to keep appointments for regular eye exams, foot exams, and the importance of protection from infection and doing A1C tests.
A1C is a blood test that reflects the overall blood glucose levels for the last several months. Supportive services and stress management should be provided. The importance of maintaining the personal hygiene should be emphasized due to the possible implications on people’s healthiness. Sharing of self care experiences with other individuals with diabetes should be promoted. Evaluation The evaluation of the teaching can be done by asking the questions and allow the clients to verbalize the understanding of the topic. The nurse can reinforce the teaching until the client understands.
The client is able to demonstrate the glucose testing, medication administration and the meal planning if the education is successful. Besides the care taker can also evaluate the client’s perception to the disease condition and the management. Regular follow up and home care requirements must be evaluated systematically. Conclusion Betty Neuman’s (2010) model is a flexible, complete and holistic approach to nursing practice. This model helps the patients to regain control on own comfort and wellbeing through nursing education and support.
Neuman’s (2010) model is widely used in the world as a comprehensive and multidisciplinary guide for excellence in education, management, research and nursing career. The bases and perceptions of the theory are going to be significant in future upcoming health care concerns. Neuman’s (2010) model proved that its strength and holistic perspective are correlated in healthcare system. By using this theory, care takers are able to teach self-care to their patients’ . Reviewing Betty Newman and her model will bring the life style modifications and support to promote positive healthcare behaviors.