Introduction
Betty Newman was born in Ohio in 1924 and in 1947 marked the beginning of her journey as a nurse upon completing her RN diploma. In the preceding years, Newman amassed a rich knowledge in nursing ranging from nursing leadership, clinical practice, in critical care and surgical nursing. In 1966 she completed her Masters degree in mental health and since then she embarked on mental health community programs where she developed the Newman’s systems model that since then gained a lot of momentum in real clinical practice and situations (Alligood, 2013).
The theory is grounded on the following core concepts
Human being
The theory views the human being as a whole or as an open system in a dynamic state of interactions with both the internal and external environments. The theory also states that human beings are ever changing towards a dynamic state of stability or equilibrium with the environment. This implies that human beings are made up of subsystems whose interplays affect their well-being. These subsystems range from biological, psychological, developmental, and spiritual to socio-cultural. For well-being to be attained, all these subsystems must be stable (DeLaune, 2010).
The environment
This model divides the environment into two; the external environment and the internal environment. The internal environment comprises of all the influences or aspects within the clients internal system. On the other hand, the external environment comprises of all aspects outside the client’s system.
The health
Health under this theory is defined as a state of wellness or illness. When the system needs, both internal and external are met; the body achieves optimal wellness. On the other hand, when these needs are not met, illness exists.
Nursing
Newman classifies nursing as a unique field that is concerned with helping families, individuals and clients to attain optimal wellness through fine-tuning the environmental variables to meet the health needs or well-being needs of an individual (Neuman ,2002).
Stability and hence well-being is characterized by energy exchanges between the body and its environment and the subsequent lines of defense available to protect the body from any environmental alteration. According to this model, the system has three basic lines of defense. The flexible line of defense is the external most mechanism that protects the normal line of defense from stressors. On the other hand, the normal line of defense is the state of wellness and is flexible since it can expand or contract. When stressors subdue the normal line of defense, it can be termed as weak (Flaherty, 2013). However, over time, people develop adaptability mechanisms or coping mechanisms that determine the normal line of defense’s response to stressors. The line of resistance is activated when the normal line of defense is subdued by the stressors, resulting to a reaction symptomatology. Energy exchanges between the body and its environment thus determine the ability of these lines of defense to protect the system. When the body dissipates more energy to the environment (Entropy) the line of defense is weakened, and the system moves towards illness. Therefore, the role of the nurse or nursing is to adjust the environmental variables as a way of increasing negentropy and strengthening the lines of defense. Likewise, when the body receives more energy from the environment, (negentropy), it moves to a state of wellness.
Working of the systems model
The theory is based on the premise that the human is more of an open system that responds accordingly to the stress factors from the intra, inter, and extra personal environments. The range of stressors will impact on client variables such as the physiological, sociocultural, psychological, developmental, and spiritual (Alligood, 2013). The human body is protected by a line of defense that is usually flexible and the stressors will impact on the line of defense which in one way or another will run the wellness and health of the individual along the wellness-illness continuum. As such the theory does not separate wellness, illness, the individual and the environment into different entities but rather classifies them as a circulating system. The health of an individual is thus subject to all these adopts and how they correlate.
At normality, the health of the individual is described as the normal line of defense that is usually protected by a flexible line of defense. This flexibility of the line of defense determines whether the individual’s health is in the wellness state or the illness state. The stressors from the environment will always impact/invade this line of defense. If the stressors are not strong enough to break the line of defense, then the human will remain in the wellness state. However, if the stressors can break through the line of defense, the health of the individual will gradually shift from the wellness state to the illness state along the wellness-illness continuum. Depending on the energy levels within the body, the normal line of defense will be restored at the normal level or even at a higher it was previously.
This then brings the link between the theory and the nursing process. Nursing interventions are applied based on the needs of the individual, and these needs are dictated by the status of the individual along the wellness-illness continuum. Nursing interventions fall in three major categories, the primary interventions, the secondary interventions and the tertiary interventions. The primary interventions are preventive in nature, and they occur long before the invaders impact on the line in defense or the system (Flaherty, 2013). Thus, it facilitates to strengthen the line of defense so that all stressors will find it hard to invade the body. Secondary interventions shortly after the stressors have invaded the body. These interventions seek to restore the wellness and health of the individual to normal states. Tertiary interventions, on the other hand, are applied after the reestablishment of the secondary prevention, and they act to facilitate this reestablishment of the line of defense.
As demystified by the above diagram, the human body is on constant exchanges with the environment. Wellbeing is achieved when there is stability between the client and the environment. However, when the environment produces too many stressors that subdue the client’s line of defense, illness occurs. As such, the role of nursing is to intervene where the body is subdued by environmental stressors and through nursing interventions, fine-tune the environmental variables in a manner that favors wellbeing.
Application to nursing
The Neumann’s model has bane regarded as a suitable model for today’s healthcare system that has its premise on patient-centered care and holistic approaches. There are six major steps that would facilitate the application of the model in the nursing process. Initially, the assessment of the individual is done. This assessment involves determining the stressors, the characteristics of the lines of defense, the degree of reaction, interaction of the individual with their environment and the coping factors necessary to achieve optimal wellness (Delaune & Ladner, 2010).
The second step is to make a diagnosis after an interpretation of the collected data and information. This interpretation should seek to identify the appropriate health seeking behaviors suitable to the individual, ineffective coping and thermoregulation as well as ineffective coping mechanisms that would ultimately hinder the healing process. Once these have been identified, the third step is to formulate the goals that both the patient and the nurse seek to achieve in regard to the patient’s healthy and their interaction with the environment. Upon these goals, the nurse and the patient focus on developing a care plan response to the data collected, the set goals and the preferences of the patient (Flaherty, 2013). The care plan’s objective is base on strengthening the life of defense so that into the future, the stressors will find it hard to invade the system.
The fifth step is the implementation phase. It is important to note that the care plan will employ the three forms of intervention, primary, secondary, and tertiary, to achieve optimal results. The final phase of using the Neumann’s model is the evaluation phase where an analysis of the restoration of the health balance for the patient is made. If the equilibrium has been achieved, the care plan is continued or discontinued depending on the needs of the patient. If the response is poor, the nurse and the patient will again focus on developing a more responsive care plan.
Conclusion
Nursing is a field that is deeply grounded on the concept of care. As such various theorists such as Betty Newman through keen observation of nursing procedures and practices have identified gaps within care and subsequently developed theories aimed at addressing these gaps and promoting care. Newman’s theory can be termed as a towering principle in nursing and encompasses all aspects of care (DeLaune, 2010). Acknowledgment of the role of the environment in healthcare is very important. Agreeably, the human body is in a constant struggle to counter the environmental influences through expansion of the body’s line of defense or adaptability. However, sometimes the body is unable to achieve a healthy equilibrium with the environment, calling for an external support in the form of nursing.
References
Alligood, M. R. (Ed.). (2013). Nursing theorists and their work. Elsevier Health Sciences.
DeLaune, S., & Ladner, P. (2010). Fundamentals of nursing. Cengage Learning.
Flaherty, K. M. (2013). Neuman Systems Model in Nursing Practice. Nursing Theory: Utilization & Application, 200.
Neuman, B. M., & Fawcett, J. (2002). The Neuman systems model. Pearson Education, Incorporated.
