The Neuman Systems Model: what it is and what does it explain about patients

A nurse is defined as a person whose job is to assist or care for the sick, injured or injured under the prescriptions of a doctor, or help the doctor or surgeon to carry out their practices in a adequate.

The World Health Organization (WHO) reveals that there are some 28 million nursing professionals worldwide. Their ranks have increased by 4.7 million between 2013 and 2018 but, nevertheless, the current figure continues to leave a deficit of 5.9 million health professionals globally.

Nursing models and theories seek to describe, establish and examine the phenomena that make up the practice of general nursing. This set of trends and techniques encompasses philosophical, scientific, theoretical, modeling and research fronts. knowledge, in turn formed by the perception of reality that we perceive through learning and investigation.

The conceptual models in the field of nursing allow the organization of information in logical systems, develop an organized way of studying nursing (and its strengths and deficiencies), discover knowledge gaps in the mechanisms and postulated theories, provide measures to assess the degree of care in a patient in a health environment and many other things more. Together, they try to apply the discipline of nursing in the most effective and respectful way possible with the sick.

One of these important theories in the field of nursing is the Neuman systems model, proposed by Betty M. Neuman (1924-present), graduated in Mental Health and Public Health. If you want to know everything about this premise, keep reading.

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What is the Neuman systems model?

Neuman's systems model is a nursing postulation based on the individual's relationship with stress, their response to this emotion and the dynamic restorative factors in nature. This model can be divided into the 4 meta-paradigms of nursing, which are the environment, the patient, the action of the nurse and health.

Within this conceptual framework, the patient sees himself as a client (or client system) composed of innate traits in a specific environment. A person, a family, a community and even a social problem are conceived as “a set of variables, physiological, psychological, sociological, of the development and spiritual ”linked to a central nucleus based on individual survival, which is surrounded by“ concentric rings of defense ”.

We know that all this terminology may sound confusing, but stay with us, you will understand it better. The client develops a series of defenses that are used to protect themselves when interacting with the environment, the most external lines being the flexible ones and the line of defense (normal line) the limit of well-being in a moment of rest. When the innermost defense lines are broken (resistance lines), the client / patient feels a more or less severe stress, which can become a lethal threat to the entire system.

In other words, we conceive of the patient as a survival nucleus and a series of rings concentric that go from greater to lesser severity, being the line that limits the state of health the situation of normal. Neuman's systems model tries to keep the customer's system intact, protecting the outermost lines and promoting greater flexibility from the rest. Thus, the patient is prevented from getting worse faster than normal due to the progress of his disease and environmental stress.

As a summary of this theory, we can distinguish several elements that make up the patient when describing the model, from "outside in". These are the following:

• Flexible defense lines: they are the outermost layer of the client, the ones that protect the normal line.
• Normal line of defense: the level of normal health in the client. In other words, the limit between being well and not being well.
• Resistance lines: they protect the system from its imbalance and try to preserve the well-being of the patient once the normal line is broken.
• Nucleus: it is composed of the vital factors that define the species.

If you prefer, we can see the individual as an onion, which goes in layers. The most external are the casing, which, if broken, does not affect the structure. When one delves into them, the normal and resistance lines are found, until reaching the nucleus, which contains the vegetal primordium. If the core is destroyed, the entire system falls under its own weight.

The foundations of the Neuman systems model

There are 11 bases on which the Neuman systems model rests. We present some of the ones that we have found most interesting:

• The patient is a dynamic source of energy that is in constant exchange with the environment that surrounds him.
• There are many known, unknown and universal stressors. They all differ in the potential to throw the patient off balance.
• Each patient is a unique system composed of its own factors and characteristics that have a common survival core.
• The normal line of defense is used to calculate the individual welfare deviation.
• The particularities of the patient can cause that, at any moment, his resistance lines fail to protect the patient from a stressor.

Based on these premises, in the nursing field, primary prevention is applied to protect the normal line of defense and harden the more “flexible” layers of the system (flexible defense lines). Secondary prevention focuses on strengthening the lines of resistance, thus reducing the reaction to a stressor and increasing the patient's tools. Lastly, tertiary prevention tries to readapt and stabilize the patient (return to wellness) while he continues the treatment.

Besides all this, Neuman's model places special emphasis on the environment in which the patient finds himself, as it is essential for the maintenance of the balance of the system. There are 3 types of "environments" according to the model, these being internal, external and created.

The internal environment grows within the patient's own system. All the interactive forces and influences that characterize the client form this concept. On the other hand, the external environment is the physical space in which the person is, while the environment created is the subconscious mechanism that he himself generates to cope with the situation current.

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Practical applications

All of this may sound very ethereal, but we hope it has become clearer to you with the nuanced explanations. At the clinical level, Neuman's model can help nurses manage potential stressors for patients in the facilities where they work.

This stream of thought helps professionals understand the idea of ​​adversity by delineating the limits of the factors that make up a whole, the effects of circumstances, and a patient's relationship to her situation, and environment. If the nucleus and lines of the patient are known, theoretically it is possible to act accordingly and achieve a better general condition throughout the process.

You may have already noticed, but this model is not without its critics. According to pharmacological portals, the greatest of the failures presented by this postulation is, without a doubt, the lack of clarification of terms. On the other hand, it fails a bit when it comes to differentiating interpersonal and extrapersonal stressors.

Resume

As you can see, we have moved at all times in abstract terms, between lines, rings and nuclei of well-being. If we want you to have a general idea, this is the following: clients or patients are made up of layers, some external and flexible and others more delicate internal. When a stressor reaches our core, the system fails and our health can be seriously compromised. The nurses' job is that this never happens.

For this reason, the Neuman system pays special attention to the limits of each client, their particularities and the relationships they develop with the environment. The more each specific situation is compartmentalized and described, the easier it will be to avoid stressors that can jeopardize the entire individual system.

Bibliographic references:

• Bourbonnais, F. F., & Ross, M. M. (1985). The Neuman systems model in nursing education: Course development and implementation. Journal of advanced nursing, 10 (2), 117-123.
• Günüşen, N. P., Üstün, B., & Gigliotti, E. (2009). Conceptualization of burnout from the perspective of the Neuman systems model. Nursing Science Quarterly, 22 (3), 200-204.
• Haggart, M. (1993). A critical analysis of Neuman's systems model in relation to public health nursing. Journal of advanced nursing, 18 (12), 1917-1922.
• Neuman, B. M., & Fawcett, J. (1989). The Neuman systems model (2nd ed.). Norwalk, CT: Appleton & Lange.
• Reed, K. S. (1993). Adapting the Neuman systems model for family nursing. Nursing science quarterly, 6 (2), 93-97.
• Reed, K. S. (1993). Betty Neuman: The Neuman Systems Model (Vol. 11). Sage.
• Ume-Nwagbo, P. N., DeWan, S. A., & Lowry, L. W. (2006). Using the Neuman systems model for best practices. Nursing Science Quarterly, 19 (1), 31-35.