Hi there Browneyedgirl33!
First of all, lets set the historic stage:
Florence Nightingale was in all likelihood the first nursing theorist,
and she was certainly the first to look at health care from a
systemic point of view. Her theory on patient environment and its
effects on health was groundbreaking in its recognition of the
importance of the *total* patient environment: internal, external and
constructed. This was the first time a theorist had exercised an
approach to health care that attempted to look at a larger, more
inclusive picture of patient care. So, according to Nightingale,
health = the prevention of disease via environmental, (ie systemic),
Dr. Betty Neuman is a contemporary theorist whose Health Care Systems
Model builds on Nightingales original theory to include issues of
the psyche such as emotions and feelings, expectations and issues of
personal life such as finances, relationships, etc.
First, lets look at Nightingale and see how she attempted to deal
with the patients total environment, keeping in mind that she was
working in the late 1800s.
From an untitled nursing theory website,
Florence Nightingale, often considered the first nurse theorist,
defined nursing over 100 years ago as "the act of utilizing the
environment of the patient to assist him in his recovery". She linked
health with five environmental factors:
pure or fresh air
light, especially direct sunlight
Nightingale set the stage for further work in the development of
nursing theories. Her general concepts about ventilation, cleanliness,
quiet, warmth, and diet remain integral parts of nursing and health
Following is a wonderful summary of Nightingales theory/philosophy of
nursing. This summary, and the following summary of Neumans model,
offer us a great comparison of the two in terms of their meanings of
person, environment and health:
Nightingale's Philosophy of Nursing
Nightingale focused on the person as " the recipient of nursing care"
(Selanders, 1993). She believed that nurses should concentrate on the
patient and their needs, not the disease they were afflicted with. She
knew that people were multidimensional and wrote about their
biological, psychological, social and spiritual requirements.
Nightingale emphasized that people had reparative powers and that the
nurses' duty was to assist these powers as the means of returning
people to health. (Selanders, 1993)
The environment was the main emphasis on Nightingales nursing beliefs.
She clearly emphasized that clean environment, fresh air, warmth,
noise control and management of wastes and odors were ways that the
"environment could be altered in such a way as to improve conditions
so that nature could act to cure the patient." (Selanders, 1993) She
realized that internal and external environment controls were both
important to the progress of the patient's health. While she stressed
the importance of fresh air and ventilation and an environment free of
odors and waste, she knew that properly prepared food and clean water
was also necessary.
Nightingale decribes health as a "state of being well and using ones
powers to the fullest" (Creasia, Parker, 1996) Nightingale saw health
as an absence of disease, with illness a physical state. By
controlling the environment and taking care of the body, health was
Florence Nightingale's Philosophy was based on the idea that nursing
was a calling from God. Nurses were meant to ease suffering, to offer
comfort, and most of all to look after the patient's well being.
Further, Nightingale believed that nursing was a science as well as a
profession -- a noble profession -- and worked very hard to raise it
to the level of respectability by teaching technical skills and
techniques. Nurses were responsible for the day to day care of the
patient, and were limited to that function.
Application of Nightingale's Theory to the Nursing Process
Florence Nightingale stressed the importance of observation of the
patient by the nurse. In her book, Notes on Nursing, she writes:
"The most important practical lesson that can be given to nurses is to
teach them what to observe-how to observe-what symptoms indicate
improvement- what the reverse-which are of importance-which are of
none-which are the evidence of neglect- and what kind of neglect." (
In this statement, Nightingale was teaching the first step of what we
now refer to as assessment in the nursing process.
After the observation, the nurse was to record the findings and be
able to "support conclusions regarding prescribed care". (Selander,
While the concept of nursing diagnosis was not present in
Nightingale's time she did identify and address particular needs and
problems presented by the patient. Through her emphasis on
observations nurses were able to title the problems such as diarrhea,
lack of appetite, difficulty of breathing so that these
problems/condition were addressed immediately. In this manner, nurses
were able to plan their care, basing their plans on prioritization of
The plan of care that the nurse would implement, in Nightingales time,
included actions that directly related to Nightingales environmental
theory of proper sanitation, improved personal hygiene and clean, warm
environments. During this time period nurses were not only responsible
for personal care of the patient which included bathing, wound
dressing, treatments but were also required to wash the floors,
windows, walls and continue maintenance of the stove to provide warmth
for the environment. All these actions and many more, was part of the
plan of care implemented to provide the proper environment for
Since Nightingale's teachings strongly promoted observation the
patient's progress could be evaluated and reassessed. While she did
not believe in questioning the patient about their own observations
and feelings she did "determine that the evaluation of client status
was critical to the process of providing adequate care. Only then
could it be determined if the care should be continued or
We can now compare Nightingales 4 point philosophy of nursing with
Neumans 3 point plan.
Neumans Nursing Plan:
Neuman sees the person as being a multidimensional, whole, dynamic
system, but primarily with interrelationships between five variables
The person has a basic 'core structure', comprised of survival
mechanisms, including organ function, temperature control, genetic
structure, response patterns, ego, and what are termed 'knowns and
commonalities'. This core is protected by flexible 'lines of defence'
and 'lines of resistance'.
The 'person' may in fact be an individual, a family, a group, or a
community in Neuman's model.
The person is seen as being in a state of constant change, or as an
open system in reciprocal interaction with the environment (ie
affecting, and being affected by it).
Neuman sees health as being equated with wellness. She defines
health/wellness as "the condition in which all parts and subparts
(variables) are in harmony with the whole of the client".
As the person is in a constant interaction with the environment, the
state of wellness (and by implication any other state) is in DYNAMIC
equilibrium, rather than in any kind of steady state.
Neuman envisages a wellness-illness continuum, with the person's
position on that continuum being influences by their interaction with
the variables and the stressors they encounter.
The environment is seen to be the totality of the internal and
external forces which surround a person and with which they interact
at any given time.
These forces include the intrapersonal, interpersonal and
extrapersonal stressors which can affect the person's normal line of
defence and so can affect the stability of the system.
Application of Neumans Theory to the Nursing Process:
Neuman sees nursing as 'a unique profession' which is concerned with
all of the variables which influence the response a person might have
to a stressor. The person is seen as a whole, and it is the task of
nursing to address the whole person.
Neuman defines nursing as actions which assist individuals, families
and groups to maintain a maximum level of wellness, and the primary
aim is stability of the patient/ client system, through nursing
interventions to reduce stressors.
Neuman states that, because the nurse's perception will influence the
care given, then not only must the patient/client's perceptions be
assessed, but so must those of the caregiver (nurse).
Neuman sees a 3-stage nursing process:
nursing diagnosis - based of necessity in a thorough assessment, and
with consideration given to five variables in three stressor areas
(Neuman developed her own assessment and intervention tool)
nursing goals - these must be negotiated with the patient, and take
account of patient's and nurse's perceptions of variance from wellness
nursing outcomes - considered in relation to five variables, and
achieved through primary, secondary and tertiary interventions.
For more information on Neumans model, there is a fine explanation at
the following website; part of it is copied below:
Description: The Neuman Systems Model provides a comprehensive,
system based conceptual framework. Originally designed to be used in
nursing it can be used by other health professions.
The purpose of the model is to provide a unifying focus for
approaching a wide range of nursing concerns and for understanding
basic nursing phenomena: the client, the environment, health and
The model represents the client within the system perspective,
holistically and multi-dimensionally. It illustrates the components of
five interacting client variables; physiological, psychological,
developmental, socio-cultural and spiritual in relation to
environmental influences upon the client as a system consisting of
basic structure, lines of resistance and lines of defense.
The environment is broadly defined as all internal and external
factors or influences surrounding the identified client or client
system. Environment consists of three dimensions: internal
environment, external environment and created environment.
Here is a definition of environment in Neumans terminology:
Neumans Environment: The environment is seen to be the totality of
the internal and external forces which surround a person and with
which they interact at any given time. These forces include the
intrapersonal, interpersonal and extrapersonal stressors which can
affect the person's normal line of defense and so can affect the
stability of the system.
And finally here is a description of the Neuman model from Dr.
Neumans own website:
The [Neuman] model was developed not out of nursing research, but is
- the philosophy of writers such as deChardin,
- Gestalt theory,
- Hans Selye's work on stress and stress responses, and
- general systems theory.
Within the generally accepted classification of nursing theories and
models into developmental, systems, or interaction types, the Neuman
model is described as a SYSTEMS MODEL. It is usually referred to as,
and indeed Neuman's own books call it, the Neuman Systems Model. The
model is based on theories of stress adaptation, and views the person
as being a multidimensional whole, in constant dynamic interaction
with the environment. The role of the nurse is seen in terms of
degrees of reaction to stressors, and the use of primary, secondary
and tertiary interventions.
The person, with a core of basic structures, is seen as being in
constant, dynamic interaction with the environment. Around the basic
core structures are lines of defense and resistance (shown
diagrammatically as concentric circles, with the lines of resistance
nearer to the core.
The model looks at the impact of stressors on health and addresses
stress and the reduction of stress (in the form of stressors). A
stressor is ANY environmental force which can potentially affect the
stability of the system: they may be
intrapersonal - occur within person, eg emotions and feelings
interpersonal - occur between individuals, eg role expectations
extrapersonal - occur outside the individual, eg job or finance
and can occur at any time, in any number or combination.
The person has a certain 'degree of reaction' to any given stressor at
any given time. The nature of the reaction depends in part on the
strength of the lines of resistance and defense.
By means of primary, secondary and tertiary interventions, the person
(or the nurse) attempts to restore or maintain the stability of the
So, in summary, Neuman has successfully built upon the original,
groundbreaking thought of Florence Nightingale to produce a modern
healthcare system model that includes viewing the patient as an
organic whole, existing and interacting within his or her entire
I hope that this information helps you. If you have any questions,
please let me know by using the Clarify Answer button.
Thanks for a fun afternoons research!
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