APPLICATION OF NEUMAN SYSTEM MODEL IN CLINICAL PRACTICE

Neuman System Model Nursing Process Format

Neuman presents a 3 step nursing process format, known as the Neuman System Model Nursing Process Format. Nursing Diagnosis Nursing Goals Nursing Outcomes

Nursing Diagnosis

Includes the use of database to identify variances from wellness and development of hypothetical interventions.

Nurses focuses on obtaining a comprehensive client database to determine the existing state of wellness and the actual or potential reaction to environmental stressors.

Nursing Goal

Caregiver intervention strategies negotiated with client to retain, attain and maintain client/client system stability.

Based on the identified needs and the available resources.

Outcomes are specified under nursing goals in the NSM as goal outcomes to correct variances.

Nursing outcomes

Begin with nursing intervention Modes for identifying the nursing action are the

3 levels of prevention-as-intervention. Theses nursing interventions-as-prevention are

followed by evaluation to confirm that the anticipated or prescribed change has occurred.

If this is not true, then goals are reformulated. Immediate and long-range goals are then

structured in relation to the short-range outcomes.

An assessment and intervention tool

1. Intake summaryName, Age, Sex, Marital Status, referral source and related information

2. Stressors as perceived by clientsMajor stress area of health concerns, lifestyle patterns, past coping patterns, anticipating oneself in the future as a consequences of present situation, activities doing to help oneself and expectation of activities for oneself from caregivers, family, friends

3. Stressors as perceived by caregiverMajor stress area of health for client, difference of client present and usual pattern of living, client past coping patterns, anticipating client in the future as a consequences of present situation, activities of client to help himself and expectation of client (activities) from caregivers, family, friends

Summary of impression Note any discrepancies or distortion between the client’s perception and that of the caregiver as relates to the situation.

4. Intrapersonal factorsi. Physical ii. Psycho-socialculturaliii. Developmental iv. Spiritual

5. Interpersonal factors- resources and relationships of family, friends or caregivers that either influence or could influence area 4.

6. Extrapersonal factors - resources and relationships of community facilities, finances, employment or other area that either influence or could influence area 4 and 5.

Overall summary v. Physiological vi. Pshyosocialculturalvii. Developmentalviii. Spiritual

7. Formulation of a comprehensive Nursing DiagnosisIt is accomplished by identifying and ranking the priority of needs based on total data obtained from the client’s perception, the caregivers perception or other resources such as laboratory reports, other caregivers or agencies. i. Nursing diagnosisii. Nursing goalsiii. Nursing outcomes: prevention-as-intervention

Situation: Pregnant Women

1. Intake summaryName:- Age:- Sex:- Marital Status:-

Referral source :-

2. Stressor as perceived by clienti. Major stress area or area of concern:

(Possible: Nausea and fatigue, Lack of knowledge about parenting)

ii. Lifestyle patterns Work, habit, use of leisure time, exercise,

eating patterns?

iii. Past coping patterns: Experience with similar problems? If yes;

how did you manage?

iv. Anticipation for future: Expectations, possible future coping patterns? (Possible:Can be concerned about how to maintain a

healthy pregnancy and care of infant)

v. Activities doing to help oneself: Coping patterns? (Possible: Can talk with friends and family about their

experience, read article, books and watch TV on childbearing and childrearing)

vi. Expectation from caregivers, family, friends: About visit, support? (Possible: Can expect mother in law will care for the

child and husband to do household works.)

3. Stressor as perceived by caregiver i. Major stress area

(Possible: Nausea and fatigue)

ii. Difference of client present and usual pattern of living: Change in habit, work, use of leisure time, exercise, eating patterns? (Possible: Changed eating pattern)

iii. Past coping patterns: Has the client experienced similar problems? If yes; how was it managed?

iv. Anticipation for client in future:Expectations, possible future coping patterns?

(Possible: Can manage if we provide support.)

v. What can client do to help himself and what does the client expect from caregivers, family, friends?

Summary of impression :Note any discrepancies or distortion between the client’s perception and that of the caregiver as relates to the situation.

3. Intrapersonal factorsi. Physical Height: Weight: Vitals: Sleeping pattern: General condition: (Fatigue and nausea) Diet: Elimination patterns: Immunization:

iii. Developmental Age: Developmental milestone: Degree of normalcy:

iv. Spiritual: Belief system: Hope and sustaining factors:1. Interpersonal factors-

Family support: Relationships with family members Internal environment of house

2. Extrapersonal factors: Health care facilities: Day care facilities for child Employment facilities: Financial stability:

Overall summary Physiological : (Normal pregnancy with

associated stressors of nausea and fatigue) Pshyosocialcultural Developmental Spiritual

Formulation of comprehensive nursing diagnosis

1. Nursing diagnosis Nausea and fatigue related to pregnancy Lack of knowledge related to parenting

2. Nursing Goal Client will get relief from nausea and

fatigue as evidenced by absence of nausea and continue normal activities of daily living.

Client will have the knowledge of as evidenced by planning strategies for it.

3. Nursing Outcomes (Prevention-as- Intervention)I. Manage nausea and fatigue Primary:- Normal line of defense has been

invaded Secondary:-Following can be done to meet

goals: Plan daily activities to include rest period Suggest family members to support her in activities Explore types of foods and eating patterns that

decrease nausea Include food preferences as tolerated in the diet

Suggest to avoid any noxious smells during eating

Encourage small, frequent feeding rather than large feedings

Suggest not to lie down immediately after eating

Tertiary:-Can continue to encourage rest whenever possible plan daily intake of appropriate nutrients

II. Providing knowledge about parenting

Primary:- discuss parenting strategies with client, husband, mother-in-law, family, friends, caregiver and explore how these strategies may be adapted; encourages discussion with friend who has children, encourage to read about parenting in leisure times and discuss concerns

Secondary and tertiary: not needed if flexible and normal lines of defense functions effectively.

Evaluation of goals Evaluate whether nausea and fatigue are

reduced or not. Evaluate whether client has acquired

necessary information about parenting strategies or not

If not met, then goals are reformulated.