Application of the Neuman systems model to teaching health assessment and nursing process

Nursing Diagnosis, Jan-Mar 1998 by McHolm, Frances A, Geib, Kathleen M

TOPIC. A nursing theory framework for teaching health assessment.

PURPOSE. To improve teaching of health assesment and nursing process to beginng-level baccalaureate nursing students.

SOURCES. The Assessment and Analysis Guideline Tool, published and unpublished literature, personal observation, and faculty feedback were used in tool development.

CONCLUSIONS. Faculty concluded that students who could envision the connection of the Neuman Systems Model and NANDA nursing diagnoses through the nursing process would be better able to understand the nursing model and choose appropriate nursing diagnoses for client care.

Keywords: Health assessment, Neuman systems model, nursing diagnosis, nursing process

The purpose of this project was to improve teaching of health assessment and nursing process to sophomorelevel baccalaureate nursing students. Based on the Neuman Systems Model (1989,1995) concepts were identified to be included on a data collection and analysis tool. The approved NANDA diagnostic labels (NANDA, 1994,1996) were reorganized to reflect the Neuman Systems Model as represented in the tool. Guidelines were provided to connect the Neuman Systems Model and NANDA nursing diagnoses through the nursing process through the use of this tool.

Background

In 1994 the faculty of the Malone College Department of Nursing Canton, OH, adopted the Neuman Systems Model (Neuman, 1989, 1995) as the nursing model for the curriculum. Before this, the faculty used an eclectic model for the nursing curriculum. The faculty agreed with Neuman's focus on wellness, wholism, and systems thinking as foundational to nursing student education. Neuman (1995) states that wellness for any client system (individual, family, group, or community) must be considered in relation to internal, external, or created environmental stressors and system reaction to stressors. Forces or influences that are intrapersonal, interpersonal, and extrapersonal in nature characterize the environment and may exert positive or negative effects on the system. When one evaluates a system from a wholistic viewpoint, five variables-the physiological, psychological, sociocultural, developmental, and spiritual-must be considered that "are not significantly connected except with reference to the whole" (Neuman, p. 8). The system has a central core of survival factors encircled by concentric rings of barriers (the flexible line of defense, the normal line of defense, and the lines of resistance), which act as boundaries to provide protection to the system (Fawcett, 1995; Neuman).

Neuman (1995) has viewed health as optimal system stability at any designated time. Health is understood to be on a continuum, with wellness and illness on opposite ends. Use of this model focuses the practice of nursing on promoting system stability through attainment, retainment, and maintenance of optimal wellness and wholeness. The concept of prevention as intervention provides a typology of nursing actions that relate to client system stability and protective barriers. Primary prevention as intervention involves actions that strengthen the client before a system reaction is assessed. Secondary prevention involves actions that treat assessed client symptomologies that occur after system reaction. Tertiary prevention involves actions that promote wellness after treatment. Neuman stated that by "keeping the system stable, the nurse creates a linkage among the client, the environment, health, and nursing" (Neuman, p. 33).

These basic concepts of the Neuman Systems Model help students use critical thinking, which includes logic, deduction, and induction. Moreover, the Neuman model encourages students to collect sufficient data within the framework of nursing rather than medicine. Students also learn from this model that client perceptions are an integral part of the nursing process and should be included in data collection and client outcome development (Neuman, 1995).

Before adoption of the Neuman Systems Model, the Malone faculty had used Gordon's Functional Health Patterns as an organizing framework for implementing the assessment phase of nursing process in sophomorelevel nursing courses. The transition to the Neuman Systems Model led to the development of a new student clinical data collection tool, the Malone College Department of Nursing Assessment and Analysis Tool, based on the format suggested by Neuman (1995). This new Assessment and Analysis Tool (see Table 1) included a client profile (see Figure 1); stressors as perceived by client and caregiver; and intrapersonal, interpersonal, and extrapersonal factors. The intrapersonal factors included the five variables (physiological, psychological, sociocultural, developmental, spiritual) identified in the Neuman model. To help students focus on pertinent data, the physiological variable was further delineated to include sections titled Oxygenation, Circulation, Neurosensory, Nutrition and Fluids, Elimination, Safety, Rest and Sleep, Comfort and Pain, Hygiene, Skin Integrity, and Sexuality/Reproductive.