Prevention as intervention

Prevention as intervention is identified as a middle-range theory consistent with the Neuman systems model. Through an examination of anxiety research using Neuman's theory, prevention as intervention is examined for clarity, simplicity, generality, accessibility and importance. Conceptual clarity is in need of improvement to proceed with theory testing research. Until such concepts as the flexible and normal lines of defence, created environment, and the inter-relatedness of core system variables are further understood, the theory of prevention as intervention remains unclear.     

Stressors in five client populations: Neuman systems model-based literature review

AIM: This paper reports a literature review identifying and categorizing client system stressors in Neuman systems model-based studies. BACKGROUND: To date, literature reviews related to the Neuman systems model have focused broadly on all concepts of the model. The concept of stressors has been selected by the Neuman Systems Model Research Institute as the focus for an initial collaborative research project. METHOD: Cooper's five-stage integrative review method was used: problem formulation, data collection, data evaluation, analysis and interpretation, and dissemination. The Neuman systems model research literature from 1983 to February 2005 was searched using Fawcett's Neuman systems model bibliography and a follow-up review of the CINAHL database using the keywords 'Neuman systems model' and 'stressors'. A total of 87 studies published as journal articles or book chapters between 1983 and 2005 were reviewed; 13 of the 87 studies met the definition of 'stressor studies'. FINDINGS: Stressors were identified in five client populations: caregivers, cancer survivors, ICU patients in intensive care units, care receivers, and parents whose children were undergoing day surgery. The most common data collection method was the interview, and investigator-developed interview guides were most often used. Evidence of categorization of intra-, inter- and extra-personal stressors was present. The following overall stressors were identified: burden of responsibility (caregivers); awareness of vulnerability (cancer survivors); being overwhelmed (patients in intensive care units); loss of control (parents); and frustration with role changes (care receivers). CONCLUSIONS: These data could form the basis for nursing practice as well as future research within a collaborative environment. Given the existing body of knowledge concerning Neuman system model-derived middle range theory concepts in the caregiver population, the middle-range theory of caregiver role strain could be tested empirically.     

Theoretical substruction illustrated by the Theory of Learned Resourcefulness

This article describes the process of theoretical substruction and uses this process to examine the significance of Rosenbaum's resourcefulness theory for nursing research and practice. The article discusses relocation as a phenomenon of interest to gero-psychiatric nurses working with elders who have relocated to retirement communities, illustrated by the theory of learned resourcefulness. The literature was reviewed to assess the congruence between the theoretical and operational systems suggested by Rosenbaum's resourcefulness theory. A model of learned resourcefulness is presented that includes middle-range concepts, relational statements, and propositions derived from the research literature. Theoretical substruction provides a mechanism for testing middle-range theories that may contribute to nursing knowledge development.     

Using conceptual models of nursing to guide nursing research: the case of the Neuman systems model

Conceptual models of nursing inform thinking and give meaning and direction to nursing research. The Neuman systems model is used to exemplify the following five steps, which provide specific direction for conceptual model-based research: (a) Develop a comprehensive understanding of the substantive content and research rules of the conceptual model, (b) review existing research guided by the conceptual model, (c) construct a conceptual-theoretical-empirical structure, (d) clearly communicate the conceptual-theoretical-empirical structure, and (e) conclude the report with an evaluation of the empirical adequacy of the middle-range theory and the credibility of the conceptual model.     

Cultural negotiation: a constructivist-based model for nursing practice.

Combining abstract concepts from grand theories with the pragmatics of nursing practice presents a dilemma for nursing that is being addressed with the emphasis on middle-range theory. The philosophical perspective of constructivism is the foundation for a middle-range theory that links the nursing process to holism through the respective worlds and knowledge of the nurse and client. The nursing process is situated in the context of the cultural worlds of the nurse, client, and health care system and in the greater social context. This model allows the nursing process to be recast in new language that captures the interdependence of the client-nurse interaction. This model accommodates the social values and beliefs of both the health care system and the social context.     

Adapting to diabetes mellitus: a theory synthesis

One priority in nursing research is the development of middle-range theories that are applicable to nursing practice. The purpose of this article is to describe the development of a middle-range theory, adapting to diabetes mellitus, through theory and concept synthesis. The adaptation to chronic illness model explicates the conceptual relationships of the Roy adaptation model in a theory specific to chronic illness. Several concepts in the diabetes literature, self-management, integration, and health-within-illness were synthesized with the theory through examination of empirical evidence. This method of theory development increases the specificity of the existing theory and informs the application to nursing practice.     

Toward a new conceptualization of women's anger

Most theorizing about women's anger has been based on cases of troubled women who sought psychotherapy. However, theories derived from clinical practice have subsequently been phrased in terms of women in general, with no disclaimer regarding their origin. Empirical evidence refutes many widely accepted assumptions and theories about women's anger. In this article, the hydraulic model of emotion is rejected, and existential and cognitive-behavioral theories are used as the basis for a new middle-range theory of women's anger. Both trait anger (general propensity to become angry) and modes of anger expression are included in the model. Appraisal concepts, modifying factors, and outcome variables are described. The model awaits use by clinicians and validation by researchers in the 1990s.     

Teaching theory at the master''s level: Report of a national survey of theory instructors

A stratified, random sample of 100 nursing theory instructors from across the United States was surveyed to gather information on essential content and concepts, assignments, textbooks, and related information for the purpose of updating a nursing theory course. A total of 44 usable questionnaires were returned. Results showed that there is general consensus on content that is considered essential in theory courses. Additionally, theory instructors responded that grand nursing theories are overemphasized whereas more emphasis needs to be placed on middle-range and practice theories, as well as the research-practice-theory triad. It was concluded that it is time to revise nursing theory courses to make them more research and practice oriented, timely, and relevant.     

应用Neuman保健系统模式开发住院患者心理压力评估工具的可行性分析

目的 探讨应用Neuman保健系统模式(Neuman systems model,NSM)发展住院患者心理压力评估工具的可行性.方法 通过理论分析、文献回顾及案例分析对发展该评估工具的可行性进行具体分析.结果 证实了NSM适用于指导心理压力评估工具的研制与开发.结论 根据NSM可以有效地对非精神科住院患者所承担的心理压力进行评估,因此,在实际工作中,适合使用该模式发展住院患者心理压力的评估工具.     

Human-environment Interaction: A Modification of the Neuman Systems Model for Aggregates, Families, and the Community

The human-environment interaction model is a modification of the Neuman systems model and is a macro systems approach designed to provide an organizing framework to understand the client's relationship with the environment and to intervene appropriately through preventive, corrective, and rehabilitative measures. It assists in organizing phenomena and shows relationships of various components. The structural elements of the model include context, process, and substantive categories. The substantive parts include theoretical concepts, operational definitions, and a mental-visual picture that permits the theoretical concepts to be readily perceived and understood. The major categories are the physiologic, psychologic, sociocultural, and developmental (PPSD) variables. These are defined and applied as they relate to the health of clients. The model incorporates and illustrates the collaborative decision-making process encompassing three levels of prevention. Together, these provide a framework for action to promote, maintain, and restore the health of individuals, families, aggregates, and the community.     

Documentation of model-based practice: one hospital's experience

Nursing conceptual models have been useful tools to guide clinical practice. They help define nursing as well as provide a consistent and efficient means of communication within the profession. One of the greatest challenges in implementing the use of a nursing conceptual model is adjusting current documentation to reflect the model appropriately. When the Neuman Systems Model was adopted as the nursing conceptual model to be implemented at our institution, we faced this challenge. Throughout the process of implementation, various documents were revised or created, including the Pediatric Admission Database and the Neuman Process Summary. In addition, registered nurses were educated on how to improve documentation in order to better use the concepts of the model.     

A Comparative Analysis of Neuman''s Model Using the Individual and Family as the Units of Care

This paper identifies the similarities and differences between nursing an individual as client and nursing a family as client when one uses the Betty Neuman systems model as a guide to practice. Several factors contribute to the decision to initiate an individual- or a family-centered approach. Within the context of the Neuman systems model, a clinical situation illustrates several characteristics that highlight features of the two approaches.     

Improved Management of Depression Through Nursing Model Application and Critical Thinking

Nurse practitioners need to integrate nursing and medical models as they practice. This paper explores the application of the Neuman systems model and critical thinking to synthesize, analyze, and evaluate the complex and multidimensional aspects of depression from nursing and medical perspectives. An integrative approach using this model and critical thinking facilitates appropriate management. Multiple nursing diagnoses for depression are derived by Neuman systems model variables. Primary, secondary, and tertiary interventions appropriate to both this model and critical thinking are recommended.     

A community nursing center for the health promotion of senior citizens based on the Neuman systems model

This article describes a community nursing center that provided clinical learning experiences for students from two schools of nursing. Work at the center was based on the Neuman systems model, which views the client as a system in interaction with environmental stressors. Nursing interventions focused on health promotion services for an underserved elderly population. The benefits of using the Neuman systems model for patient care, education, and research are outlined.     

The middle-range theory of nursing intellectual capital

Title. The middle-range theory of nursing intellectual capital Aim. This paper is a report of the development of the middle-range theory of nursing intellectual capital. Background. Rising healthcare costs and advances in technology have contributed to the need for better understanding of the influence of nurses’ knowledge, skills and experience on patient and organizational outcomes. Method. The middle-range nursing intellectual capital theory was developed using the strategies of concept and theory derivation. The principles of research synthesis were used to provide empirical support for the propositions of the theory. Findings. The middle-range nursing intellectual capital theory was derived from intellectual capital theory to make it relevant and applicable to a specific aspect of nursing, continuing professional development. It proposes that the nursing knowledge available in healthcare organizations is influenced by variables within the work environment, and influences patient and organizational outcomes. Conclusion. The middle-range nursing intellectual capital theory should be tested in different healthcare systems and in different settings and countries to determine its effectiveness in guiding research.     

Prevention of elder abuse: Betty Neuman health care systems approach

It is estimated that as many as 2.5 million elderly persons in the United States every year are victims of abuse, neglected, battered, or otherwise deprived of their rights, usually by those on whom they are most dependent for care. Although there is no clear consensus on what constitutes or causes abuse, it is widely accepted that this national tragedy has growing implications for the future. Presented here are definitions of abuse, trends that have impact on the incidence of elder abuse, trends that have impact on the incidence of elder abuse and also theories of causation. In addition the Betty Neuman health care systems model is presented as a framework for the clinical nurse specialist to utilize in developing a plan of care aimed at preventing abuse while maintaining the integrity of the family. This framework and accompanying generalized plan of care could easily be adapted to other types of intrafamily violence.     

Research based on the Roy adaptation model: last 25 years

Two key events lead to the prominence of links among Roy's grand theory, derived middle-range theories and the design of research. The author in this column describes this work in two formats. Essential details of two areas of research are presented in episodic form-the first is work on secondary analysis of Roy model-based research over 40 years and the author's study of persons' cognitive recovery from mild head injury. The second is a project on re-conceptualizing coping and adaptation processing in sequential detail within the context of work in the field and the significance of on-going work for nursing practice.     

Using the Neuman systems model for best practices

Human beings with unmet needs related to their health and illnesses are the central focus of the domain of nursing. It is proposed in this column that nurses who conduct their practice from a nursing theory base, while assisting individuals and families to meet their health needs, are more likely to provide comprehensive, individualized care that exemplifies best practices. The Neuman systems model has been widely acclaimed to guide practice, yet specific examples are few in the published literature. The purpose of this column is to present two case studies based upon Neuman systems model; one case is directed toward family care, and the other demonstrates care with an individual. Theory-based exemplars serve as teaching tools for students and practicing nurses. These case studies illustrate how nurses' actions, directed by Neuman's wholistic principles, integrate evidence-based practice and generate high quality care.