Holistic Nursing Practice: Implementing The Neuman Systems Model

• Holistic nursing care is an approach that examines the patient’s physical, psychological, and spiritual well-being. 
• The Neuman Systems Model is one of the most widely used holistic techniques. 
• Understanding all the components of the Neuman Systems Model will make implementation easier to increase positive patient outcomes.
  

What is the value of holistic nursing and should nurses implement this type of care with all patients?  According to the American Holistic Nurses Association, holistic nursing involves “healing of the whole person” (AHNA, 2017).   

Nurses need to consider the entire patient when giving care which includes the mind, body, spirit, socioeconomic background, culture, and environment.  It involves seeing the patient as a physical, psychological, and spiritual whole.   

There are various models to implement when administering holistic care, but one of the most popular ones is known as the Neuman Systems Model.  In order to implement the model successfully, it is important to fully understand it’s many facets.

Neuman Systems Model

The Neuman Systems Model, created by Betty Neuman, was introduced in the mid 1970’s and its philosophy is based on a holistic approach, reality, and wellness.  The model includes four nursing paradigms: person, environment, health, and nursing (Butts & Rich, 2018).   

Neuman’s approach was one that understood how life is interconnected to the spirit and minds of individuals and the importance of how the spirit and mind can influence one another.  One of the main focal points of Neuman’s model involved understanding that individuals react differently to various stressors, whether they are actual or potential stressors.   

Neuman also believed that the causes of stress can be identified and taken care of through nursing interventions based on identifying the problem, mutually agreeing on set goals, and implementing the idea of prevention as intervention.    

In the model, Betty Neuman defined human beings as a “client/client system, as a composite of variables such as physiological, psychological, sociocultural, developmental, and spiritual” (McEwen & Wills, 2014, p. 150).  This client system may be an individual, family, a group, or a community.

Understanding The Components

In this model, the individual or group is considered a unique and open system. Each individual is a dynamic, constant energy, that changes with the surrounding environment.   

According to Neuman’s model, the environment can be categorized by internal, external, and created environments.  The stressors in one’s life affect the patient’s line of defense and each patient typically has a normal response to environmental stressors.  The human being is a basic structure surrounded by successive rings as a system.   

If the system is not sufficiently protected by the flexible rings of defense, any stressor may pass through the normal ring of defense and create a reaction in the individual.  If there is a deviation in this line of defense, resistance can be found by the patient.   

The important role of nurses in this model is to take prevention in the primary, secondary, and tertiary levels in order to help the patient move towards reconstitution.

Guiding Principles of Neuman Systems Model

• Primary prevention – uses inpatient assessments and interventions, identification, and reduction of possible risk factors 
• Secondary prevention – relates to symptoms noted after a reaction to stressors, appropriate prioritizing of interventions, and treatments to help reduce the stressors  
• Tertiary prevention – relates to adjustment processes and maintaining factors that assist the patients toward primary prevention of the stressors  

A patient who experiences work-related stressors may exhibit the following stressors at different levels.   

At the primary level, the actual stressor has not yet invaded the system (patient) and stress management is being maintained by relaxation and anger management techniques.   

Secondary prevention takes place after the system (patient) has reacted to an invading stressor and can include medication to treat the symptoms, if needed, and opportunities for the patient to verbalize feelings and concerns.   

Tertiary prevention includes a re-assessment of the patient’s ability to perform independently and maintain one’s support system.  With the focus of this model being based on individual uniqueness and many known and unknown universal stressors that can cause instability for those affected, the model can be used with various populations. 

The Variables

In dealing with patients under this model, the patient is viewed holistically and the following variables must be considered:

• Physiological variables – relates to the structure and function of the body
• Psychological variables – refers to the mental processes and relationships
  
• Sociocultural variables – deals with system functions that are related to cultural and social expectations
• Developmental variables – relates to processes involving one’s development over the patient’s lifespan
• Spiritual variables – refers to the influence of spiritual beliefs in one’s life

Holistic Nursing Implementation

As nurses, our goal is to define the appropriate action in stress-related situations and view the possible reactions that our patients exhibit toward stressors.  Nursing interventions should focus on helping the patients to adapt, adjust, retain, restore, and maintain a certain degree of stability in relation to the patients’ variables and environmental stressors.   

The Neuman Systems Model can assist nurses to identify the intra, inter, and extra personal stressors that are found among patients.  By identifying these stressors, the nurse has a more comprehensive assessment related to caregiving and can better explain and achieve primary, secondary, and tertiary interventions.   

All these factors in combination result in more effective problem-solving among patients and fully implementing holistic nursing approach which in turn leads to increased resolutions and identification of stressors.

Strengths of Neuman Systems Model

• Great flexibility for all areas of nursing 
• Logically consistent 
• Emphasizes primary prevention 
• Relatively simple with components that are easy to understand

Weakness of Neuman Systems Model

• Need for further clarification of certain terms used within the model 
• Stressors involving both interpersonal and extra personal factors need to be more clearly defined
  

The Bottom Line

The Neuman Systems Model can be used in any health care setting due to various clinical tools and assessments that guide holistic nursing and the early identification of stressors present.  By using these clinical tools and assessments, the nurses/practitioners can more effectively diagnose, treat, formulate goals, and identify outcomes specific to each patient.   

If the holistic nursing approach is utilized in any area, training needs to take place to ascertain that all health care personnel understand its components and focus.  The main goal of the Neuman Systems Model in any healthcare setting is to achieve optimal patient stability and positive outcomes. Read here for more on utilizing holistic nursing to improve patient care. 

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