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The 10th Biennial International Neuman Systems Model Symposium, Akron, Ohio, April 21-22, 2005.

The 10th Biennial International Neuman Systems Model Symposium was titled “Nursing Theory as Context for Evidence Based Practice”. The conference provided a unique opportunity to exchange ideas regarding the role of nursing theory in the world of nursing practice. Participants examined a fundamental issue: What is the future of nursing theory in the 21st century? Abstracts for the papers and posters presented at the symposium are listed alphabetically by author below. Please contact the presenters directly for information about their work.

Developing Performance Improvement in Nursing Services:
A Systems Model Approach

Pam Baker, MSN, RN, CNS
Akron Children's Hospital
Akron, OH

Performance Improvement (PI) activities are essential for provision of consistent evidence based patient care, improvement of workplace conditions and the overall growth of healthcare systems and hospitals. The presentation will highlight efforts of a private, non-profit children’s hospital to improve patient care by implementation of a nursing shared governance system, restructuring of the PI system, identification of the challenges of involving staff in the clinical PI process and communication of PI project outcomes. A literature review of PI activity development revealed key lessons that provided a foundation for the change process. Examples of current PI activities will be used to show how these topics are related to the current clinical environment and patient outcomes. Presentation objectives include a  SEQ CHAPTER \h \r 1description of differences between PI activities and quality measures, SEQ CHAPTER \h \r 1 development of PI activities in conjunction with research and evidenced based practice revision, implementation of the new PI process, barriers and aids to successful PI activity change process and the impact of legal regulations and accreditation standards on PI activity reporting.


Assessing the Efficacy of Teaching Strategies That Influence Student Nurses’ Concept of Spirituality

Sarah Beckman MSN, RN
Cheryl Bruick-Sorge MS, RN
Sanna Boxley-Harges MA, ANP, RN
Becky Salmon MA, RN
Indiana University - Purdue University Fort Wayne
Fort Wayne, IN

Spirituality has different meanings to different individuals with minimal definitions documented in academe. Dr. Betty Neuman (1989, 1995) identifies the spiritual variable as an innate component of people that positively or negatively affects all other variables. Neuman (2002) further states that as thought patterns are positively affected, the body becomes increasingly nourished and sustained through positive use of spiritual energy empowerment. Spiritual development empowers the client system toward well being by positively directing spiritual energy for use first by the mind and then by the body.

The purpose of this paper is to examine the efficacy of the teaching strategies currently in place in the nursing curriculum in relation to the development of the spiritual variable of the Neuman Systems Model. Social utility of the NSM in academe is explored in this work. Educational outcomes are critical to determine the effectiveness of instructional methodologies. A pilot study of several classroom assessment initiatives that contribute to decision making on future research design will be examined. Findings from these initiatives will be discussed. Projections by the researchers on impact for future research initiatives will be shared. Several implications on curriculum development will be discussed.


Wellness: Influence of Spirituality in the Relative Importance of Neuman's Five Variables of Person

Gloria Linden Buck, PhD, RN
Athens Technical College
Snellville, GA

The relative importance of five dimensions of person/health to perceived overall individual adult health was examined in a group of 233 adults, ages 19-78 (M = 45, SD = 10.56). Cluster analysis of written self-report scores from established instruments on physical health status (SF-36), general psychological well-being (GWB), psychosocial maturity (MEPSI), family functioning (FACES II), spiritual experiences (INSPIRIT), and spiritual well-being (SWB), revealed that the levels of functioning of all five personal variables described by Neuman (1995) are relevant to the understanding of the perceived overall health of individual adults. Discriminant analysis was used to validate the cluster solution and further examine the characteristics of the clusters. Individuals in the healthy group with scores above the mean on all five personal variables were easily categorized, constituted the largest cluster in this healthy sample, and reported the highest overall health. Several different configurations of person/health dimensions were associated with poor overall health and were more complex than those associated with good overall health. Hierarchical multiple regression demonstrated that spirituality did not mediate the effects on overall health of the other four dimensions. However, results demonstrated that spirituality is important to overall adult health, and that INSPIRIT made an important independent contribution to explaining perceived overall health.  Responses to an open-ended question that asked participants “Think of your life as a whole (your health, decisions, relations with others, eating and sleeping habits, work, leisure, etc.). Is there any one thing that stands out, that influences all aspects of your life?” If so, “What is it?” were examined. Themes were identified that correlated with the five personal variables described by Neuman. Findings from this study have significance for individuals, families, and health and family practitioners. Consideration of the whole person is important for promotion of health/wellness and prevention or treatment of illness, with consequent overall reduction in health care costs. Findings also support the relevance of Neuman’s model for conceptualizing and promoting wellness in family practice and health care.

Bolded portion indicates focus of presentation (in context of study as a whole)


An Exploratory Study on the Perceived Health Status Changes in Criminally Victimized Older Adults

Helen M. Burnett, RN, MSN
W. A. Foote Memorial Hospital
Jackson, MI

The purpose of this exploratory descriptive study is to identify whether the elderly perceive changes in health status as a result of victimization. Purposive sampling was used to identify elderly who had experienced burglary, vandalism, or larceny. Their names and source of victimization were retrieved from the local police chief and county sheriff. The Neuman Systems Model was used as the framework of this study.

Twenty-one elderly victims of contact and non-contact crimes were interviewed. It was anticipated that the interview process would lend itself to identifying those health-related issues that could arise after victimization. A second interview with five additional questions were utilized in a second round of questioning to clarify if effects of the victimization, or lack of effects, could be related to a previous experience of a similar nature, resulting in a conditioned response in the subjects. The average number of comorbidities was three per victim. Their contact with being victimized was within the previous 12-18 months. The county of record was a smaller town with a population of 158,422. Results from the research study demonstrate no perceived change in health status by the subjects. However, three subjects experienced short-term sleepless nights and one has an ongoing fear of crime. Installation of alarm systems and outside lighting increased the subject’s sense of security. Subjects found it important to maintain a familiar lifestyle, continue with life as usual, and maintain their health with regular checkups. Support of family and friends was found to be of significant help to the subjects.

While this study did not demonstrate any findings with dramatic changes, a replication in a larger community, with more significant crime may offer identification of opportunities for education of law enforcement and the development of victim support systems specific to the needs of the older adult.


Contributions of the Neuman Systems Model to Survival of the Discipline of Nursing: A Dialogue

Jacqueline Fawcett, PhD, FAAN
University of Massachusetts Boston
Boston, MA

The purpose of this facilitated dialogue is to identify and evaluate evidence of the actual and potential contributions of the Neuman Systems Model to survival of the discipline of nursing. The dialogue will be framed by the six questions listed below. Participants will provide answers to each question within the context of their individual and collective understanding of the value of nursing as a distinct discipline.

·        Do you think the discipline of nursing can survive?

·        How do you celebrate nursing as a distinct discipline?

·        In what ways are you a champion of nursing as a distinct discipline?

·        What evidence documents the contributions made by the Neuman Systems Model to the survival of the discipline?

·        What is the quality of the evidence documenting the contributions made by the Neuman Systems Model to the survival of the discipline?

·        What can you do to strengthen existing evidence and add new evidence of the contributions made by the Neuman Systems Model to the discipline?

The dialogue should energize the participants in such a way that they will assume leadership of endeavors needed to ensure survival of the discipline in their respective work environments.



The Neuman Systems Model: A Healing Touch Perspective

Opal A. Freiburger, Ed.D., R.N.
Indiana University - Purdue University Fort Wayne
Fort Wayne, IN

Consumers are exploring multifaceted options for achieving optimal health within an advancing and complex healthcare environment. In a "cure" focused world of medicine, the concept of "healing" continues to emerge as a means to enrich health and the quality of life. Healing Touch, founded by Janet Mentgen, was first offered as a pilot project program in 1989. Currently, the program is taught throughout the United States, Canada, Mexico, Australia, New Zealand, Europe, South Africa, and South America.

The philosophic base of the Neuman Systems Model incorporates a "dynamic perspective of energy and variable interactions with the environment to mitigate possible harm from internal and external stressors" (Neuman, 2002, p.12). Health is described as a manifestation of living energy that is available to preserve and enhance system integrity. The Neuman wellness-illness continuum depicts a continuous flow of energy between the client system and the environment. Disrupting forces (stressors) may invade the protective lines and affect the client system energy levels (Neuman, 2002, pp. 12-25).

Healing Touch is a complementary energy based approach to health and healing. It uses touch to influence the energy field that surrounds the body and the energy centers that control the energy flow from the energy field to the physical body. The practitioner assesses the client to determine areas of imbalance in the energy system and selects specific techniques to clear, energize, and balance the human and environmental energy fields (Colorado Center for Healing Touch).

Aspects of the human energy system and its interactions with the environment, possible effects of disruptions in the flow of energy, and various interventions will be described from both a Neuman Systems Model and a Healing Touch perspective.


An Integrative Review of Stressors in the Neuman Systems Model Research Literature

Eileen Gigliotti RN, PhD
Louisa DiGerolamo, RN
Caroleann Skalski, RN
College of Staten Island/City U. of New York
Staten Island, NY

Purpose Because the NSM Research Institute seeks to build on completed NSM research and because the stressor concept is the most frequently studied NSM concept, the purpose of the present study was to review the NSM research literature to:

1.      Identify “stressor” studies

2.      Describe populations studied

3.      Identify data collection methods and assessment instruments

4.      Categorize identified stressors as intra, inter, or extrapersonal in nature

5.      Identify commonalities in identified stressors and assessment methods across populations

Conceptual Framework Cooper’s (1983) five-stage integrative review process (problem formulation, data collection, data analysis, data synthesis, and dissemination) guided this project.

Methodology Using Fawcett’s 2003 NSM bibliography, research studies published as journal articles/book chapters were collected and reviewed. Once stressor studies were identified, the investigators developed a coding sheet and independently reviewed each study. After independent review, investigators met to establish inter rater reliability and synthesize findings.

Results Of the 79 collected NSM studies, 12 were identified as stressor studies. That is, a major purpose of the study was to assess relevant stressors in a population. These 12 stressor studies concerned the following populations: caregivers (6), caregivers/care receivers (1), ICU patients (2), cancer survivors (2), and parents whose children were undergoing surgery (1). Data was collected by interview in 10 studies and 2 studies employed surveys. Six studies used investigator-developed assessment tools, 2 employed the NSM Interview Guide, 2 employed standardized tools and 2 employed no tool. The most frequent stressors were lack of family support and lack of information from health care professionals (interpersonal); uncertainty about future and concern for personal health (intrapersonal); and finances (extrapersonal).

Discussion and Implications Lack of information from health care professionals, was identified as being amenable to nursing intervention. Nursing diagnosis, outcomes, and interventions are proposed using NANDA-NIC-NOC.


Presence and Performance - Key Issues of Nursing Ethics

Dr. Michel GMJ Jansen
University of Professional Education Utrecht
The Netherlands

What is, from an ethical point of view, the connection between the standard of professional nursing conduct and patients’ needs for care? This question reveals the key problem of my thesis. Current ethics are unable to solve this problem adequately because they are not focused enough on the unique character of the nursing practice. From a philosophical point of view nursing is a complex professional practice. Nursing ethics has to clarify the moral implications of that view.

Professional nursing care can be characterised by three coherent dimensions, revealing three areas of tension. The three dimensions and the corresponding areas of tension can be represent in a model as a triple layered cube, containing the three levels of professional practice. This triple layered cube expresses the ontological dimension. Upon this ontological dimension, so to speak, act two different dimensions: an epistemical and an ethical dimension. The epistemical dimension concerns the tension between two rationalities, a scientific-functional and an existential rationality. The ethical dimension concerns the tension between two diverging ethical orientations: a universalistic duty-centered ethics and a situational virtue-centered ethics. These elements in the various dimensions require forms of integration and synthesis. That is the main target of Nursing Ethics. On one hand current healthcare ethics is oriented on duty and justice, on the other hand on virtue and care. This present study seeks to find a form of synthesis between these two orientations or to express it more accurate: seeks to find a synthesis between the various way of thinking.

The main question emerging from this perception is: how can recent studies on identity and moral liability by the French philosopher Paul Ricoeur, synthesising the various elements of the three layered model, support the development of Nursing Ethics?

The concepts ‘presentie’ (presence) and ‘prestatie’ (performance) express the essence of my argument, not on their own but in cohesion with each other. Presence in the shape of solicitude (that is the term used by Ricoeur), obtains a threefold meaning: presence of oneself to oneself, presence of oneself to a known other, presence of oneself to the unknown other with whom one constitutes society. ‘Prestatie’/performance refers to capacity and courage to act adequately. ‘Prestatie’, going back to his original Latin denotation in the Latin verb praestare, refers also to the moral concepts confidence, dedication and fidelity. Praestare means to excel and to vouch for someone. So a ‘prestatie’ is the best possible act which by effectiveness and efficiency is also confidence-building. ‘Presentie’ and ‘prestatie’ go with each other because nursing is focused on presence in performance and performance with presence.

The moral complexity of the nursing practice, as expressed in the above mentioned model is demanding for everyone who wants to be a nurse. That demanding character of the profession is best expresses with the notion ‘normative professionalism’. Normative professionalism related to nursing indicates the ability to relate the existential quality of one’s own life to the content of one’s occupation and to the social-political context of that particular occupation. Thus, nursing implies not only technical and functional acting but personal and committed acting too. It implies also the courage to advocate patients interests towards institutional forces. After all, normative professionalism indicates self confidence and professional assertiveness, which enables the nurse to choose and to justify choices.


Nurses Get the Third Degree - Implementing Neuman Systems Model

Kimberley J. Johnson-Crisanti, MS, RN, CNM
Helen Burnett, MSN, RN
Jacalyn Leibowitz, MBA, RN
John R. Sturtevant, MSN, RN
Brenda Rowley, BSN, RN
Foote Memorial Hospital
Jackson, MI

The administration of Foote Health Systems presented a challenge in December 2002 to our Division Nurse Practice Committee (DNPC), to investigate choosing a nursing theory to guide our nursing practice. A sub-committee of interdisciplinary staff and professors from the adjacent Community College was drafted to review our options. The field was narrowed down from six to two after a comparison was made of their components against our mission and vision statements and standards of practice: Orem and Neuman.

The sub-committee was divided into two teams, comparing theorist’s components to our documentation, JCAHO, structural strengths and weakness, and its applicability to an interdisciplinary approach. Each team developed a Power Point presentation that was shown at DNPC twice, which included discussions to sway members to vote for their theorist. At the final vote in August 2003, a decision was made for Neuman Systems Model (NSM) as the theory of choice to best promote “Evidenced Based Practice” in an interdisciplinary system.

In October 2003, NSM Committee was established to educate staff and implement the NSM into the organization’s nursing practice. Education began with an introduction to NSM through slide presentations, luncheon seminars and a full day conference presented by Dr. Neuman on her nursing model. Currently a computer-based self-learning module is being developed on NSM to enhance the staff’s knowledge.

Our future goals include modifying the organization’s nursing philosophy, standards of care, and medical records systems to incorporate NSM into the nursing process. The implementation process will take approximately three years, and we will face the obstacles of staff resistance, the perception that nursing theory has little impact on nursing practice and the general bureaucracy associated with hospital systems. The effectiveness in providing care through theory-based practice based on NSM will be continually evaluated and modified as necessary.


Comfort Theory: A Framework for Magnet Status Application

Katharine Kolcaba, PhD, RN, C
University of Akron
Akron, OH

One way that nurses are defining their hospital practice is by applying for Magnet Status. Administrators have great incentive to promote this process, because certification by the American Nurses Association is one criterion for being selected “best hospital” in geographical regions and specialties. Before starting the application process, nurses in a New Hampshire hospital chose Comfort Theory as their theoretical framework because it fit their collective philosophy of care. This framework now guides their selection of positive and holistic outcome measures, methods for documentation of those measures, and even the conditions of nursing practice. Comfort Theory is ideal for this purpose because, as a mid-range theory, it contains only six concepts or variables, each at a low level of abstraction. Therefore each variable is easily defined, implemented (as a comfort intervention), and/or measured as a holistic outcome of care. Additional features of Comfort Theory, as explained in this presentation, are that (a) it is easy to apply because nurses agree and are familiar with the idea of patient comfort and their own comfort in delivering care; and (b) it provides a context to explain, direct, and predict patient/family comfort, related health seeking behaviors, and desired institutional outcomes. Data that are obtained through consistent measurement of valued outcomes then become empirical evidence for best practices in accordance with stated objectives and philosophy. For nurses who value holistic and family centered care, choosing a congruent and easy-to-use framework is an opportunity to state their values and objectives of care in a “loud and clear” message to patients, families, administrators, and evaluators. To contribute to the art and science of nursing, a normative theory for care provides guidance beyond intuition, facilitates consistency of practice and data collection throughout an institution, and forms the basis of a mission statement and even patient-centered advertising slogans.



Dinosaurs, Conceptual Models and Knowledge Development

Lois W. Lowry, DNSc, RN
East Tennessee State University
Johnson City, TN

Are there commonalities among the terms dinosaurs, conceptual models and nursing knowledge? This paper challenges us to reflect on the possibility that the current climate in nursing may be leading to the extinction of conceptual models, much as environmental changes led to the demise of the dinosaurs. The effect on nursing of changes in the health care environment and in the delivery of nursing care based upon biomedical models is discussed. Is nursing remaining true to its social mandate to develop and use knowledge unique to the profession in its practice and research. Countervaling trends that can promote knowledge development in nursing worldwide are also presented. In conclusion, the necessity for conceptual models as an integral part of the knowledge needed for the professional practice of nursing is emphasized.


Utilization of Outcomes Assessment to Demonstrate the Efficacy of the Neuman Systems Model


Lois W. Lowry, DNSc., RN, Moderator
East Tennessee State University
Johnson City, TN

Three related papers are submitted for this session. The purpose of this session is to demonstrate the value of effective evaluation for educational program development and for quality patient care in institutions that are Neuman-based. The first paper entitled Development and testing of an evaluation instrument for Neuman-based programs will describe how a Neuman specific instrument was developed and used in a longitudinal study of graduates to assess how well they internalized and used the model in practice. The second paper entitled Program assessment using Neuman-based evaluative instruments to influence curriculum development will demonstrate further development of instruments specific to Neuman-based programs, and their effect on student learning and program evaluation. The final paper, A research framework for evaluating the implementation of the Neuman Systems Model in Emergis Psychiatric Institute will explain the design and progress of an evaluation plan for quality patient care. The three papers not only demonstrate the applicability of Neuman-based instruments for evaluating both education and practice to meet the goal of evidence-based outcomes; but also, show how a continuing process of evaluation over 15 years has served to validate the Neuman Systems Model.


Utilization of Outcomes Assessment to Demonstrate the Efficacy of the Neuman Systems Model

Lois W. Lowry, DNSc., RN, Moderator

Part 1: Development and Testing of an Evaluation Instrument for Neuman-based Programs

Lois W. Lowry, DNSc., RN
East Tennessee State University
Johnson City, TN

The purpose of this paper is to present how one Neuman-based educational program designed and implemented an evaluation tool to test the efficacy of using the Neuman Systems Model as a framework for curriculum. The faculty hypothesized that students who internalized model concepts would practice according to its precepts. Tool development will be described, and findings from a 5-year longitudinal study of graduates presented. The hypothesis about internalizing the concepts was supported. The practical use of the model after graduation had mixed results. Curriculum changes, as a result of these findings will be discussed. The importance of this paper, however, is to illustrate the first step in a continuing process of evaluation that lends supporting evidence that the Neuman Systems Model is an appropriate framework for practice and education.


Utilization of Outcomes Assessment to Demonstrate the Efficacy of the Neuman Systems Model

Lois W. Lowry, DNSc., RN, Moderator

Part 2: Program Assessment Using Neuman-based Evaluative Instruments to Influence Curriculum Development

Sarah Beckman MSN, RN
Cheryl Bruick-Sorge MS, RN
Sanna Boxley-Harges MA, ANP, RN
Indiana University - Purdue University Fort Wayne
Fort Wayne, IN

The significance of utilizing Neuman-based evaluative tools in program assessment is the primary focus of this paper. Three tools will be presented. The Lowry-Jopp Neuman Model Evaluation Instrument (LJNMEI) provides valuable program outcome data. The Nursing Assessment Guide and Student Clinical Evaluation Tool provide interim and exit data. The discussion will include how the findings from these evaluation initiatives contribute to the review, development, maintenance and revision of the NSM theory-based curriculum. The program’s most recent NLNAC Self Study (2000) and specific areas of the Master Evaluation Plan will be featured. Evidence continues to grow and validates the importance of a theory-based approach in nursing education. Research findings also validate the efficacy of the Neuman Systems Model as a useful conceptual framework for nursing education programs. Discussion and audience response will be integrated with the two additional paper presentations at the end of this session.


Utilization of Outcomes Assessment to Demonstrate the Efficacy of the Neuman Systems Model

Lois W. Lowry, DNSc., RN, Moderator

Part 3: A Research Framework for Evaluating the Implementation of the Neuman Systems Model in Emergis Institute for Mental Health Care

Andre A. Merks, Drs, NcN, RN
Emergis Institute for Mental Health Care

Some 6 years ago the NSM was chosen to become the means for nurses and support staff to deliver patient care in Emergis, an institute for mental health care in Zeeland, Holland. This presentation will give an inside view of the research activities which are an important part of the implementation process of the NSM model in Emergis. The variables studied through the research project have been derived from the hypothesized effects of implementation of the NSM as found in the literature, and from the variables that the Steering Committee identified as improvements that can be expected. In Emergis the first ward, psychiatry for elderly, has completed the implementation of the NSM. The second data collection is also completed. The presentation will explain the initial results of the 6 research variables:  knowledge of the Neuman Systems Model (adapting and using the LJNMEI), implementation of the nursing process, client satisfaction, caregiver satisfaction, culture of the ward, and the quality of the care.


Asian-American Views on Child-Rearing:
Assessing the Sociocultural Variable of the Neuman Systems Model

Betsy M. McDowell, PhD, RN, CCRN
Lander University
Greenwood, South Carolina

Currently, the Asian-American population is a rapidly growing segment of the United States population and is the third largest minority group in this country. Chinese, Japanese, and Koreans account for the greatest number of Asian-Americans. Nurses working with Asian-American children and their families must understand the many culture-related practices and beliefs surrounding child-rearing if they are to develop effective plans of care for this group.

According to the Neuman Systems Model, holistic assessment of the family as a client/system includes assessing the sociocultural variable. The purpose of this paper is to present an overview of the various culture-specific beliefs that have an impact on child-rearing for Asian-American families so that nurses can provide culturally supportive care for these families. The effect of Buddhism, Confucianism, Taoism, Shamanism, and Christian teachings on expectations regarding behaviors within the family, obedience, and family roles will be described. Additionally, the influence of community social organizations, traditional healers, and the concept of balance can not be ignored by health care providers. The emphasis on excellence in the performing arts and academics as a major motivation for Asian-American children and adolescents, beginning with elementary school, is another factor that must be considered in interacting with this cultural group. Most Asian-American families utilize a combination of modern western medicine and generic folk herbs/treatment modalities when treating childhood illnesses. By examining aspects of child-rearing from a transcultural perspective, nurses will be better able to meet the sociocultural needs of this growing segment of the American population.


The Implementation and Further Integration of the NSM in the Elderly Division of Emergis (Institute for Psychiatric Healthcare)

Jack de Meij, RN, MA
Emergis, Institution for Mental Health Care

Purpose of the presentation The purpose of this abstract is to discuss how the implementation of the NSM was accomplished and how the follow-up will take place in Emergis, Institution for mental healthcare, in Zeeland, Holland.

Situation Psychiatry for the elderly is a division of Emergis, that has fully implemented the NSM within all its units. The NSM has become an integral dimension of the daily care giving practice of the division. The knowledge and use of the NSM has increased significantly. The effects of the use of NSM are also visible in nursing administration. Research shows also effects in relation to quality of care and the level of methodical performance of nursing.

Goals Before the implementation Emergis had general goals:

-  improvement of the standards of care

-  improvement of the methodical practice in nursing

-  further professionalization of the nursing discipline

The implementation process has ended. In a certain way this process was special, because of the research that has been performed. Standards were measured before the implementation and the measurement has been repeated afterwards.

Results Research has been performed before and after the implementation process. The following results are reported:

-  significant  increase of the knowledge and use of the NSM

-  improvement of quality of care performance

-  improvement of employee satisfaction

-  improvement of methodical practise in nursing

An unexpected result was the synergy between Quality management and the implementation of the NSM.

Developments and Application of the NSM in the Future Now that the NSM is implemented and therefore a regular part of the vision and working procedure, new questions arise:

- What is the best way to maintain and enlarge the knowledge and skills in relation to the NSM?

- How can we share this knowledge and gain new perspectives in our own situation?

- Are there other sources where we can find the NSM expertise?

- A specific aspect is the question in what way the NSM effects the cooperation between the nursing discipline and the other disciplines as doctors, psychologists and social workers.


Childhood Experiences of Appalachian Women Who Have Experienced Intimate Partner Violence During Adulthood

Amy Reeves, PhD, APRN, BC
East Tennessee State University
Johnson City, TN

Recent national surveys in the United States estimate one in five females will experience abuse by an intimate partner during her lifetime. Previous quantitative research linked childhood victimization to repeated victimization in adult relationships. This qualitative study explored the lived experiences of childhood in eight female victims of intimate partner violence who were born and reared in southern Appalachia. Interviews were analyzed using a descriptive-interpretative phenomenological method, as described by Van Manen. The three essential themes from childhood are identified as: living ‘as if’ an orphan; surviving in chaos; and, manifesting a devalued self. These themes are congruent with quantitative literature about intimate partner violence. After analyzing the data, it was found that the Neuman Systems Model provided a comprehensive perspective for linking the data to a nursing theoretical framework that is used to guide practice, education and research; thus extending nursing science. Through increased awareness of personal stories, previous negative attitudes toward victims can be altered and behaviors changed, leading to improved nursing care.


Expressive Writing:
Minimizing Threats Associated With Clinical Education

Susan Parnell Scholtz, RN, DNSc
Moravian College
Bethlehem, PA

Clinical education has the potential to be perceived as a threat to professional nursing students. Rather than intervening when a student is in crisis, perceived threat and performance anxiety could possibly be circumvented through prevention as intervention.  Based upon the current emphasis on stress related to clinical education, the psychotherapeutic effects of expressive writing, and the lack of effective interventions to reduce stress, Scholtz's Theory of Reframing Threat Apperception was developed. This theory is a synthesis of Neuman's Systems Model, Lazarus Stress Theory, Riskind's Looming Vulnerabilty Model, and Pennebaker's Expressive Writing Paradigm. This theory postulates that expressive writing as an intervention enables the person to temporarily distort a threat through reframing which decreases threat apperception and facilitates positive learning outcomes.  The purpose of this longitudinal, repeated measures quasi-experimental study was to test selected elements of this model. The effects of an expressive self-regulation writing task as compared to a disclosure, trivia, and no writing task prior to clinical education on reframing threat apperception were examined in a convenience sample of 161 baccalaureate generic nursing students in 5 northeastern Pennsylvania colleges.  Pagana's Clinical Stress Questionnaire was the instrument used to measure cognitive appraisal of threat, challenge, benefit, and harm experienced prior to clinical education. Although results of RANOVA showed no significant differences in threat apperception among groups, additional findings showed students in the self regulation writing group had a decrease in apperception of threat and an increase in challenge prior to clinical education. The findings of this study suggest there is a trend in the data that supports this theory. Replication of this study using a larger sample size is recommended.


Evaluating Pain Management Delivered by Direct Care Nurses

Jane Tapp, MSN, RN, BC
Summa Health System Hospitals

Pain management is a complex process with multiple elements, which impact outcome. It can be difficult to assess the effectiveness of pain management delivery. The primary purpose of this study was to investigate variables, which impact pain management delivery on one nursing unit. A secondary purpose was to develop an evaluation tool to assess pain management on a patient care unit. Five variables that affect pain management are nurses’ knowledge, nurses’ care delivery, pharmacological management, unit logistics and clinical resources.

A retrospective chart audit was completed for a convenience sample of 60 abdominal surgical patients on their second postoperative day on one general surgical unit. The nurses on that unit were given a survey on knowledge and beliefs regarding pain.

Nurses on the unit (n=23) completed the Nurses’ Knowledge and Attitudes survey Regarding Pain (Ferrell and McCaffery, 1996) which has a reliability r>.80 and an internal consistency alpha r>.70. The nurses also completed a demographics questionnaire. The PI developed a pain management chart audit tool to evaluate delivery of care for pain.  Thirty patients’ charts were audited prior to educational inservices on pain management for the nurses. A comparison group of thirty patients’ charts were audited 12 months after the pain management inservices on that same unit.

Nurses had a mean score of 69.4% (range 48-87%) on the knowledge survey. The LPN mean score 67% was not significantly different (p=.59) than the RN mean score of 70%. The chart audit, which evaluated pain management, had a mean score of 18.6 (SD 3.7), for patients  managed before the nurses received education. The mean score for patients’ pain management after the nurses, received education was 12.8 (SD 4.5). This was significant improvement in nurses’ delivery of care for pain management. The internal consistency of the chart audit tool before the inservice was
a =.52 and after educational inservices a =.62. Individual items on the tool were evaluated using Fisher Exact test. Documentation of pain assessment and pain goals were not done prior to inservice. Post inservice pain goals were documented 100% and pain assessments showed a significant improvement in documentation (p=5.2 x 10-16). The sample of patients audited after the inservice had fewer side effects, Chi-square p=.0027. Prompt management of side effects is dependent on the occurrence of an unusual event, which was fewer in the second group of patients. Pharmacologic management, not effected by nursing actions,  showed negative trend tests when comparing the two groups of patients, method (Z = - 1.7516), type of medication (Z= -0.7583), administration (Z= -1.6903), and timing (Z= -2.6171).

Nurses demonstrated better knowledge regarding general pain management and assessment than the use of analgesics. Educational interventions did affect the delivery of care. The internal consistency of the tool did increase after the inservices, which indicates that the nurses responded more consistently after education. However, the resulting
a is low which suggests the tool is not significantly reliable to estimate individual performance based on such a small patient sample. Pharmacologic management items on the tool need to be reevaluated for a reason not picked up by this tool, for managing a patient in a particular way. The small sample affects the ability to draw any conclusions about pharmacological management.


Use of the NSM in Interfaith Health Ministries

Kathleen O. Vito, DNSc, RN
LaSalle University
Philadelphia, PA

This poster presentation describes a survey in progress. The survey explores the use of the NSM in interfaith health ministries and parish nurse practices in a mid-Atlantic area.  There are many active nurse practices in churches located in Southern New Jersey, South Eastern Pennsylvania and Northern Delaware. The tradition of parish nursing in contemporary times began in the 1980’s under the direction of a Lutheran pastor, Granger Westberg. He named the specialty Parish Nursing although many faiths besides groups that define themselves as a parish have incorporated health ministries with nurses. Not all the parish nurses have uniform preparation for this role although continuing education programs under the guidance of the International Parish Resource Center (IPRC) pervade as a common preparation for nurses. The IPRC position on educational level for parish nurses is that all have a baccalaureate degree or higher in addition to their basic preparation course of 37 contact hours. However this standardized curriculum does not emphasize the use of specific nursing models to guide and structure practice.

Previous articles in the literature and conference papers on parish nursing have not reported or described many examples of parish nurse practice that is theory based.

The NSM is an excellent model to guide this specialty in nursing which is defined utilization of nursing knowledge with a spiritual perspective. Parish nurses strive to serve not just the physiological, but also the psychological, developmental, socio-cultural and spiritual needs of their parishioners. The Parish nurse is focused on population based care and health promotion and protection in the congregation. The purpose of this survey to determine if Parish Nurses use the NSM in interfaith health ministries or if they are even familiar with the model. The sample is recruited from the membership of regional interfaith ministries organizations and Parish Nurse councils.


Application of the NSM/OS in a School Nurse Practice

Kathleen O. Vito, DNSc, RN
LaSalle University
Philadelphia, PA

The purpose of this presentation is to describe a unique public school nurse clinical practice based on the Neuman Systems Model (NSM) from 2002-2004. This school nurse practice is after hours as it involves the activities of a high school marching band. Activities for the band are outside the normal school nurse hours and setting. Situations can arise needing the services of a school nurse for health promotion, injuries and illnesses. There are chronic illnesses among the students such as asthma, diabetes, fibromyalgia and mental health disorders. These potential and actual health problems require nursing prevention/intervention at the primary, secondary and tertiary level and in diverse settings such as football stadium bleachers, school buses, along parade routes or at band competitions. The NSM is used to structure the practice because it is comprehensive but also flexible for this unique clinical area. The assessment, care planning and documentation of care taxonomy developed by Newman (Stanhope & Lancaster, 2004) for a population of aged in a nursing center was adapted for use with this population. The Newman taxonomy merges the NSM with the Omaha System Intervention Scheme (NSM/OS) to organize data collected according to the NSM variables and also to code categories of stressors, client system (intra, inter or extra) and level of nursing prevention/intervention. The NSM/OS provides a useful tool to describe and quantify the activities of the nurse. By law, the public school board is responsible for the health and safety of the students on all field trips. This project demonstrated the importance of the nurse’s role from the NSM/OS aggregate data of coded encounters of students and the nurse over a three-year period. A three-year trend of NSM/OS data indicates an increase of encounters with interpersonal systems and an increase in assessment of alterations of the spiritual variable.


Designed Music Environment in the Cardiac Catheterization Laboratory- The Perceived Effects of Various Sound Delivery Systems

Birgit Pedersen Weeks RN, BS, BSN, CCRN
Northwest Hospital & Medical Center
Seattle, WA

1.         To compare patient’s subjective experience of no music, a room music sound system, and a patient focused music sound system (sound pillow).
2.         To investigate the differences in patients’ experience in relation to control variables (gender, race, age, and location).

Conceptual framework:
Music is beneficial for cardiac catheterization patients to reduce anxiety and improve well-being. Comfort Theory proposes such an environment is soothing, comforting and conducive to healing. The relationship between patient effects and the type of sound delivery system has not been examined. Possible variations of the music environment and their effects related to control variables have not been described.

This is a randomized, controlled study with 297 patients in three locations: Seattle USA, Toronto Canada, and Aalborg Denmark. Each site randomizes 99 patients into 3 groups: no music, speaker music, and sound pillow music. The music sound environment consists of special composed music (Niels Eje, Denmark). Patients’ perceived response is measured by a five graded Lickert Scale, and perceived anxiety by a ten graded Lickert Scale. Differences in patients’ experiences are measured in relation to control variables by nonparametric statistical methods comparing the results of variables in various patient groups.

The study is currently in progress and preliminary findings will be presented. Expected results are: sound pillow is superior to ceiling speaker, music is superior to ‘no music’ irrespective of sound source and control variables; music results in reduced anxiety and improved well-being.

Nurses can create a holistic health care approach by introducing music as a comfort intervention.  Patient’s perceptions of increased well-being and reduced anxiety will support changes in current practice.

Designed music environment can lead to improved patient satisfaction and patient outcomes.