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The 11th Biennial International Neuman Systems Model Symposium was held in Ft. Lauderdale, FL in February, 2007.

The 11th Biennial International Neuman Systems Model Symposium was titled “Celebrate Community: Culture, Collaboration, and Competence: A NSM Perspective”. 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.


 The NSM Lessens the Struggles in Transitioning to a New Curriculum

Sanna Boxley-Harges, MA, RN, ANP

Sarah Beckman, MSN, RN

Cheryl Bruick-Sorge, MA, RN

Purdue University @ Ft. Wayne

Ft. Wayne, IN



The Neuman Systems Model (NSM) provides a strong framework around which faculty members who teach in different programs are able to come together to develop a generic bachelor of science nursing curriculum. The development of the new generic bachelor of science curriculum includes additional entrance points for licensed practical/vocational nurses and non-bachelor registered nurses and an exit point for students who prefer to earn only an associate degree. The development of a new generic bachelor of science curriculum also brings many challenges to faculty members who have long embraced what is commonly known in the USA as a two plus two nursing program in which students first graduate with an associate degree, attain RN licensure, and then complete two more years of education at the upper level to earn a baccalaureate degree.


In the educational atmosphere of a two plus two program there are differing cultural climates of teaching: one more technical and one more professional. Abstract and concrete thinkers struggle to establish a connectedness. Varying degrees of “buy in” to a nursing theory based curriculum also add challenges to developing a new generic BS curriculum even though the associate degree curriculum had been utilizing the NSM for twenty-five years. However, the adoption of the NSM for the new generic bachelor of science curriculum provided the springboard for discussions that facilitated the process of transitioning the two nursing curriculums into one. Discussions of NSM concepts in the development of the conceptual framework helped individual faculty to begin internalizing the new curriculum and leaving behind ownership of their respective curriculums. This presentation focuses on the dynamics of transitioning and the utilization of the NSM in the process.

Using Simulations to Improve Students’ Critical Thinking Skills in a

Neuman-based Undergraduate Program


Cheryl Bruick-Sorge, MA, RN

Becky Salmon, MS, RN
Purdue University @ Ft. Wayne

Ft. Wayne, IN


             Incorporating clinical simulations into nursing curricula is an effective approach in preparing nursing students with the skills they will need for safe and competent practice.  Simulations incorporating human simulators provide nurse educators an innovative way to teach students about “real world” nursing.  In this Neuman-based undergraduate program, simulations are utilized throughout the curriculum.  During simulations, students employ NSM concepts as they assess and care for their simulator “client”.

            A life-like human simulator, housed in the nursing campus lab, can be programmed to have life functions such as breathing, pulse, and heart rhythm.  Scenarios using simulators are designed to resemble clinical situations within “real life” time restraints.  A major goal of simulations is to assess and improve students’ knowledge of theory, assessment, psychomotor skills, and use of technology.  An element of the scenario directs students to identify “client” stressors; implement appropriate primary, secondary and/or tertiary preventions; and formulate wholistic nursing diagnoses.  Students’ critical thinking skills are promoted through active learning, collaboration, and prioritization.

For students, simulations simplify reality by focusing on aspects intended for learning and controlling environmental factors that can interfere with learning.  Depending on the focus of the scenario, students may work independently, in pairs, or in small groups.  The student is an active participant in the scenarios that occur in a safe environment.  Students receive immediate feedback with time to discuss the process and outcomes with faculty and peers. 

For faculty, simulations are a teaching method that is multifaceted and challenging.  In addition, faculty must develop quality simulation scenarios, which is a time consuming but essential process. 

Feedback is very positive from both faculty and students who use simulations. Ultimately, students benefit from simulations by expanding their level of competency and achieving greater learning in a safe, dynamic, and stimulating environment. 

Rehabilitation of the Chemically Impaired RN Using the NSM Framework

 Patricia Dittman PhD(c), MSN, RN, CDE

Nova Southeastern University

Coral Springs, FL


American Nurses Association continues to estimate that about 6%-8% of the registered nurse population has a substance abuse problem. The most concrete evidence of this phenomenon of professional impairment is the number of disciplinary actions taken by the state licensing boards for nursing. The National Council for State Board of Nursing reports that 68% of all state board actions stem from impaired actions by the nurse related to substance abuse. Professional impairment involves mental and physical dependency and or disabilities that occur during the interaction between the nurse's personal qualities and the individual work environment.

 Using the Neuman Systems Model with its conceptual framework of “Prevention as Intervention” this qualitative, phenomenology pilot research study looks at professional impairment and the successful registered nurse in the recovery phase of  the State of Florida’s Intervention Project for Nurses (IPN) rehabilitation program. The purpose of this study is to understand the lived experience of the nurse who has successfully completed the rehabilitation phase and how to determine possible risk factors in their past that influenced vulnerability to professional impairment. The conceptual framework “Prevention as Intervention” from the Neuman Systems Model describes three dimensions primary, secondary and tertiary prevention with client/client systems as its central core. The concept of prevention is interlaced in the IPN’s alternative to discipline program that values the nurse’s self evaluation, recognizing individual triggers to chemical substances and support structures that help to prevent future chemical dependency experiences.

 The study identified the five themes of altered values, sensation seeking behaviors, pre-determined factors, masterminding and personal and professional awareness into a model of professional impairment. Exploring the lived experiences of these nurses provided understanding and early risk factors identification that will assist with prevention, education and early intervention.

A Medical Mission Team as an Aggregate Client

 Barbara T. Freese, EdD, RN, FRCNA

Lander University

Greenwood, SC


In July 2006, the author led a team of volunteers on a medical mission trip to Honduras. The purpose was to provide basic medical care to Hondurans who live in villages without access to physicians or clinics. The team included 22 persons from six states, with physicians, nurse practitioners, a physician assistant, registered nurses, a physical therapist, two nursing students, three high school youth, and several laypersons. During the week in Honduras, the team held six clinics and provided basic medical care for 1,750 patients.  As team leader, the author was responsible for planning and organizing the trip, and for details related to the living arrangements, food, water, transportation, translators, budget management, work assignments, exchanging money, and spiritual growth for each team member.  The Neuman Systems Model provided a holistic framework to conceptualize the team as a client system, and to analyze the physiological, psychological, sociocultural, spiritual, and development needs of this diverse group of persons.


This presentation will describe how the author used the Model to view the team as a client, and to analyze team members’ needs in each variable.  It will also describe the trip experience itself, and explain how the team provided primary medical care across language and cultural barriers.

Understanding Reconstitution

 Karen Reed Gehrling, PhD, RN

Malone College

Canton, OH


Reconstitution has been a component of the Neuman Systems Model since its inception.  It is defined as the determined energy increase related to the degree of reaction to a stressor, and represents the return and maintenance of system stability following treatment for stressor reactions (Neuman, 2002). It also can be viewed as a feedback mechanism from the input/output of secondary intervention.   As such, reconstitution can be used to describe how the client system recovers from stressors and begins the journey to return to a state of wellness.  Little has been written about the process or how nursing interventions can support it.  In addition, there is a dearth of information regarding the importance of the sociocultural influences during the reconstitution process.


This paper will discuss the theoretical issues of reconstitution and particularly focus on the sociocultural aspects of the process.  Interviews conducted with African American women who have recovered from postpartum depression will be presented to illustrate and support the theoretical aspects of reconstitution, describing the process the women experienced during recovery.  In their own words they will discuss issues such as denial, privacy, coming to terms and acceptance of the situation as well as unique aspects of post partum depression from an African American point of view.

Finally, the importance of understanding the reconstitution process will be discussed; particularly how such knowledge can be used by nurses to support clients in attaining and maintaining wellness in numerous situations.

Neuman Systems Model: A Theoretical Perspective for Researching
the Meaning of Faculty Preparation for Online Education

Annette G. Greer, PhD (c), MSN, RN

Maria Clay, PhD

East Carolina University


Study Purpose: The purpose of the study is to describe nurse faculty development or training prior to, during, and after teaching their first course online and perceived level of preparedness to teach online.


Conceptual Framework: The following assumptions developed from the Neuman systems model frame this research:

1.      Nurse faculty represents a wholistic open and dynamic system subject to stressors.

2.      Online teaching is a stressor initiated through interpersonal, intrapersonal, and extrapersonal cultural changes in delivery of nurse education.

3.      The capacity of the nurse faculty system to maintain stability of the central core, lines of defense, and lines of resistance is dependent upon the level of faculty development intervention (primary, secondary, and/or tertiary).

4.      The time at which the intervention is initiated will impact the nurse faculty perceived preparation to teach their first course online.

5.      Primary interventions are those faculty development or training opportunities taken prior to teaching online for the first time, secondary are those taken during, and tertiary those taken after teaching on line for the first time.


Methodology: Descriptive phenomenology is the qualitative tradition selected to explore the lived experience of nurse faculty. Faculty must have taught a minimum of 1 course online during the last three academic years while employed fulltime with teaching responsibilities in an academic setting.


Results/Discussion/Implications: Will be completed by January 2007 and ready for presentation February 2007. This research will contribute to the application of the Neuman systems model in guiding research in nurse faculty development.

Discovering Strengths of Homeless Abused Women

Jean Croce Hemphill PhD, APRN, BC
James H. Quillen VA Medical Center

Mountain Home, TN


Purpose: The purpose of this qualitative study was to investigate the experience of discovering strengths of homeless abused women. Method: An emancipatory feminist, existential phenomenological research design was used. Seventeen homeless abused women participated in facilitative dialogues that explored experiences of strength and assisted in consciousness raising by self discovery of perceived strengths. The dialogue was focused on three aspects of strength: how the women felt strong, strategies used to become strong, and barriers they had to overcome in order to attain strength. Four levels of analysis were used to identify themes of strength expressed in the words of the participants. Themes of strength were organized into a thematic structure.  Findings: Themes of strength, using the participant’s words, were organized within more global themes representing (a) characteristics of strength, (b) strategies used by the women to feel strong, and (c) barriers that the women overcame. Balance, Protection, and Environmental Obstacles were identified as global themes. Discussion: The unexpected premise of strength awakened an understanding of homeless women’s positive qualities and their personal uniqueness, a finding supported by their engagement into dialogue. This study validates the premise of Hall and Stevens (1991) that giving voice to homeless abused women’s world from their vantage point, interests and values can be emancipatory. It expands Draucker and Stern’s (2000) theory of forging ahead in a dangerous world and Neuman’s Systems Model’s theory of perception of women’s created environments (Neuman, 1995; Neuman & Fawcett, 2002) by facilitating discovery of their perception of personal resources and strategies of survival within the context of extreme societal barriers and danger.

 Use of a Mid-Range Theory to Guide Culture Change in

Health Care Institutions

Katharine Kolcaba, PhD, RN, C

University of Akron

Akron, OH



A theory is a starting point for organizing institutional change – much like a blueprint for building or renovating. Goals of health care institutions for undertaking major “remodeling” vary, but often are targeted to achieving national recognitions such as Magnet Status (ANCC) or the “Gold Seal of Approval” (JCAHO). In order for a theory to be useful, it should be compatible with an institution’s culture and mission, be easily understood, and be simple enough to guide practice and research. The theory should also present an expanded vision of what the institution can become if major culture change is undertaken.

Comfort Theory (CT) is a useful mid-range theory or “blueprint” because of its interdisciplinary language, its operational tools, its testability, its transcultural applicability, and its inherent implications for “being strengthened” through increased comfort. CT has two foci for application: comfort of patients/families and comfort of staff.  Because of these features, CT has been chosen by several hospitals who sought to improve their practice environment. An example of a typical organizational CT “blueprint” is presented.

CT is compatible with the Neuman Systems Model (NSM) in the following ways: (a) “comfort needs” in CT are labeled stressors in NSM, (b) interventions are targeted to those comfort needs or stressors, (c) intervening variables are explicated and known to impact of the plan of care in both theories, and (d) both theories can be applied at all three levels of prevention. Basic assumptions about the nature of holistic human beings are the same. However, because it is a grand theory, the NSM has many more concepts at a high level of abstraction, and most have no specific measures for operationalization and testing the theory. Discussion is invited about how fully developed instruments for measurement of patient/family comfort can be utilized to test the NSM.



Using the Neuman Systems Model (NSM) to go from Raw Data to Information and Knowledge


Margaret Louis, RN, Ph.D.

University of Nevada, Las Vegas

Las Vegas, NV



A survey of a parish with over 6000 registered families resulted in 2574 responses. The returned questionnaires produced over 100,000 data points.


To make these data usable by the pastor and the parish council, the parish nurse looked for a way to bring the Data to the Information level and then hopefully to the Knowledge level for use. The information and knowledge were needed for identifying and developing and refining programs, services, etc. to meet the needs of the parish. These needs encompass not only spiritual areas but the broad gamut of individual and group needs.


The Neuman Systems Model with the five concepts of physiological, psychological, sociocultural, developmental and mostly spiritual concepts offered a base for the initial organization of the Data to Information. The Information was then analyzed for Knowledge through application of some of the NSM prevention as interventions. The NSM concepts enhance the basic philosophy of Parish Nursing and are useful in meeting the needs of a dynamic urban parish.


The proposed presentation will discuss the NSM as a viable model for informatics to move raw Data to Information and Knowledge levels for use or implementation.



The Accreditation of a Dutch Mental Health Institute and the

Role of the Implementation of the Neuman Systems Model


A.A. Merks, Drs., BcN, RN

Emergis, Institute for Mental Health Care




Some 8 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. The first ward, psychiatry for elderly, has completed the implementation of the NSM two years ago. At the same time this ward was accredited by the HKZ-standards. HKZ stands for Harmonisation of quality review in health care and welfare, and is a Dutch initiative of health care providers, patients/clients and insurers comparable to JCAHO standards. This paper will discuss how the use of the NSM enabled HKZ certification standards to be met.


HKZ produces ISO 9001 compatible certification schemes for various types of health care and welfare institutions in Holland.  The HKZ-model consists of nine headings, which all together describe the whole of organisational processes that should be subject to review. The first three headings refer to primary processes with a professional input: from intake and care delivery to evaluation. Standards in these headings are emphatically formulated from the perspective of the patient/client. The remaining six headings relate to supportive items and processes: policy and organisation, human resource management, research and development, documentation, environment and materials, and services delivered by third parties. The norms in these sections are strongly ISO related. The HKZ-certificate makes visible that the system is reviewed to the standards which have been described in the certification diagram for the mental health care.

The Neuman Systems Model appears to be compatible with the HKZ standards for accreditation. During the HKZ accreditation process it became clear once the NSM is implemented, a significant number of the HKZ certification standards already were satisfied.



Sleep Quality in the Cardiothoracic Surgery Patient


Kristina Nelson, RN, APNS

Southern Adventist University

Collegedale, TN



Background and Significance

            Hospitalized patients are at greater risk for poor sleep than their community counterparts, and dissatisfaction with sleep is a frequent complaint among hospitalized individuals. Patients identify multiple sources of sleep disturbance including pain, noise, interventions by the healthcare team, anxiety, and uncomfortable sleeping conditions.

Purpose and Hypothesis

            The purpose of this study is to observe patients’ quality of sleep on a cardiothoracic step-down unit before and after institution of a Quiet Time policy from eleven o’clock in the evening until five in the morning. It is hypothesized that these patients will have improved sleep quality after institution of the Quiet Time policy.

Framework and Design

            The Neuman Systems Model provides a theoretical framework and describes a wholistic and wellness approach to nursing in which the individual is in constant interaction with the environment. The Quiet Time policy represents primary nursing interventions as described by Betty Neuman.

            The study utilizes a comparative group quasi-experimental design. A sample of at least 36 will be drawn from patients on a 32-bed cardiothoracic surgery step-down unit.

            The Verran and Snyder-Halpern Sleep Scale (VSH Sleep Scale) is utilized as a subjective measure of sleep quality through analysis of sleep disturbance, effectiveness, and supplementation. The Factors Influencing Sleep Questionnaire (FISQ) is used to measures patient perception of etiology of sleep disturbances through the use of 5-point Likert scale questions.

Data Analysis

            Data from the VSH Sleep Scale will be analyzed using t test to determine any statistical difference between patients’ perceived sleep quality before and after institution of the Quiet Time policy. Data from the FISQ will be analyzed utilizing means for each item. Comparison between pre- and post-institution of Quiet Time will be accomplished using t test. Pearson r will be used to find significant correlation between demographic data, sleep quality, and factors influencing sleep.


            This study is currently in progress. Final data collection will occur August 2006.



Promoting Critical Thinking in Pediatrics: Concept Map Development

using the Neuman Systems Model as Conceptual Framework


Dr. Wendy R. Ostendorf

Neumann College

Aston, PA



The use of concept mapping as a learning strategy to promote the development of critical thinking has been recognized in the health care literature. Concept mapping is an effective methodology to promote the acquisition of knowledge for nursing students in pediatrics. It assists students in organizing ideas in a particular content domain and explores the relationships between these ideas in a meaningful way.  This tool can be utilized to allow students to modify their ideas as new information is collected and reorganized. The Neuman Systems Model is utilized as the conceptual framework for the design of the concept map. The model provides a unifying focus to approach the client, the environment, health and nursing. The concept map incorporates the five client variables including physiological, psychological, developmental, sociocultural and spiritual in relation to environmental influences.

Concept mapping can also be utilized in the classroom setting and in an online environment to promote the acquisition of pediatric content knowledge. It avoids the accumulation of knowledge that cannot be used in making inferences and promoting critical thinking skills. It is also a tool that lends itself to promoting group work and collaboration even in an online environment.

In summary, concept mapping in pediatrics, promotes the development of critical thinking and enhancing a knowledge base in a unique way. Utilizing the Neuman Systems Model forms centralizing schemata for designing the concept map as a learning strategy.



Finding the Evidence for Evidence-Based Practice: Caregiver Support


Cristina Parasole RN, AAS
Sonya Syvertsen Larsen RN, AAS
Eileen Gigliotti RN, PhD

College of Staten Island

Staten Island, NY




The Nursing Interventions Classification System (NIC) holds great promise for the advancement of Evidence-Based Practice. However, at present, there is little research support for the vast majority of activities listed under each intervention. Therefore there is a pressing need to provide research support for most NIC interventions. One such intervention in need of research evidence is Caregiver Support (7040) which Skalski, DiGerolamo, and Gigliotti (in press) proposed can mediate the relation between caregiver responsibility/burden and caregiver role strain (depression). That is, based on a literature review of stressors in the Neuman Systems Model (NSM) they proposed a middle-range theory of Caregiver Role Strain and suggested that this theory be tested within the context of the NSM Research Institute. However, before this interventional study can be undertaken, evidence for the efficacy of caregiver support activities described by the NIC must be documented. Therefore, the purpose of this project is to:

1.      collect the most relevant and best evidence related to the efficacy of caregiver support activities

2.      critically appraise the evidence using established evidence-based practice evaluative techniques

3.      compare this evidence with the traditional caregiver support activities described in the Nursing Interventions Classification (NIC): explore coping behaviors, teach health maintenance strategies, foster caregiver social networking, identify sources of respite care, inform about health care and community resources, teach strategies to access and maximize health care and community resources, support for setting limits and taking care of self (Dochterman & Bulechek, 2004).


Melnyk and Fineout-Overholt’s (2005) guidelines concerning Evidence-Based Practice was used. A search of CINAHL, MEDLINE, PsycINFO, and the Cochrane Database of Systematic Reviews is presently underway. The clinical question of interest is: Do caregiver support activities outlined in NIC (7040) influence caregiver role strain in informal caregivers?



Chinese Parents’ Knowledge and Understanding of

Vehicle Restraint Use for Their Children


Jianhua Ren, MS candidate

Anne W. Snowdon, RN, PhD

Christine Thrasher RN(EC), NP, PhD

University of Windsor
Windsor, Ontario



Study purpose: To examine Chinese parents’ knowledge of vehicle safety restraints using the Neuman systems model as a theoretical guide;


Compare parents’ knowledge and use of vehicle restraints among Chinese in China and in Canada.


Conceptual framework: The Betty Neuman Systems Model provided the theoretical framework for this research. In this study, system stability referred to the “safety” of a child in the motor vehicle environment, whereby the child is exchanging energy and must cope with potential or imposing stressors in a motor vehicle crash. To decrease the risk of injury to children, parents’ knowledge of the child vehicle restraints as well as their awareness of improper child safety restraint use was the focus of the survey. The outcomes will instruct the appropriate educational programs to help parents to correctly use child restraint devices. The first step for nursing intervention is “assessing the client/client system’s perception of stressors, identifying the client/client system’s major problem, stress areas, or areas of concern” (Neuman, 2002). It is important for nurses to learn parents’ perception of child vehicle safety before developing an effective education program.


Methodology: A cross-sectional study, using self-administered survey questionnaire in Chinese.


Preliminary Results: Most Chinese in China have limited knowledge of vehicle restraints. Parents in China whose children are under 24 months have a better understanding of vehicle restraint use.


Discussion and implications: This study may be foundational to fully understanding the impact of child safety in the Chinese population and how it influences Chinese families in Canada.  It will help health professionals have a clear understanding of vehicle restraints using in Chinese families. Culturally sensitive intervention programs could be developed. The Neuman system model was an effective framework for informing the project design and will be used to guide the discussion and recommendation phase of the research project.



A Taxonomy of Psychiatric Nursing Diagnoses:

Developing Psychiatric Nursing Knowledge for Health Promotion

to Support Evidenced Based Psychiatric Nursing Practice


Michel A. Tarko, RPN, PhD

Anna M. Helewka, RPN, RN, BSN, MSN

Douglas College

New Westminster, British Columbia



The profession of psychiatric nursing continues to develop and refine a body of knowledge based on nursing science. In this pursuit for a body of knowledge that is specific for psychiatric nursing, it becomes abundantly clear that the North American Nursing Diagnoses Association (NANDA) taxonomy, rooted in a medical model perspective is discordant with the definition of nursing science as it relates to the practice of psychiatric nursing. The presenters will introduce session participants to a Taxonomy of Psychiatric Nursing Diagnoses. This taxonomy is based on the Neuman Systems Model for Nursing, as well as related psychiatric nursing and health promotion concepts. A holistic health assessment framework utilizing the variables from the Neuman Systems Model for Nursing for the client as an individual (psychological, physiological, socio-cultural, developmental, spiritual) integrated with concepts derived from the nursing literature will be employed to illustrate the utility and applicability of a Taxonomy of Psychiatric Nursing Diagnoses.



Moral Violations as Stressors


Rilla Taylor, EdD, MN, BSNE, RN

Florida Hospital College of Health Sciences

Sarasota, FL



Several nursing theorists note the effect of stressors on human well being and view these stressors as having central importance to nurses in care-planning.   Stressors are a central concept in the Neuman Systems Theory.


Stressors arise from the environment and from inter-personal relationships.  Neuman acknowledges stressors as arising from within the client and, in fact, refers to an internal environment as well as an external environment,--both of which may generate stressors that either threaten or actually create disequilibrium in normal functioning.


The principles of the last six of the Judeo-Christian “Ten Commandments” appear quite universally as appropriate standards for human interactions.  While cultural norms have a degree of variance in interpretation, disrespect/disgrace/insult to parents, murder, prevarication, adultery, and the covetousness which leads to theft are socially condemned throughout the world.


The question follows: are these issues only social or are they part of a deeper fundamental order that affects the individual’s physiological as well as social function?   Are there physiological changes that occur when these standards are violated?  And if so, are these changes stressors which threaten well-being or do they enhance well-being?   And if they do jeopardize human well-being, is this because of their inherent nature or is a result of the individual’s sense of “guilt”?  Are there physiological implications to the victim(s) of moral violations and his/her response to this victimization?



The purpose of the study is to review literature that explores physiological response to moral indiscretions and to develop, if there is support, the hypothesis that moral violations function as stressors that jeopardize human health and well being. While preference will be given to recent research, no arbitrary time limit will be imposed on research selected for review.



            If moral indiscretions,-- either on the part of the client or on the part of others against the client,--indeed do function as stressors (potentially producing physiological  reactions and jeopardizing human well being) nurses who recognize that fact will do well to  integrate that concept in planning and providing whole-person care.



Taking the Neuman Systems Model Online


Wendy Thomson, MSN, BSBA, RN, IBCLC

Diane John, ARNP, MSN

Sally Weiss, EdD, MSN, RN

Nova Southeastern University

Ft. Lauderdale, Fl



On of the hallmarks of a baccalaureate nursing education is the teaching of a research and nursing theory based curriculum. With the move towards online, asynchronous learning, the typical modes of teaching theory needed to be rethought.  Knowing that moving face-to-face content to an online environment is challenging, we wanted to create an exciting and interactive learning community.  Starting with an introduction to NSM, a short movie describing the theory was created.  The case study method on the discussion board to apply the theory to a practice situation was then utilized.  Having never correlated nursing practice to a nursing theory, the students framed their plan of care using the nursing process as guide.  The students were required to read each others application of NSM and offer feedback and suggestions to the plans while faculty helped facilitate the discussions and keep students on track. An interactive quiz was added to identify whether they could apply the concepts in other nursing situations.



Value of the Neuman Systems Model for Daily Practice:

Presentation of Research Results


Caroline H. van Tilburg, MSc, BcN, RN

Emergis, Institute for Mental Health Care




Eight 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. The presentation will give inside view in the results of the research activities which are an important part of the implementation of the NSM in Emergis and the benefits for the caregivers.


The first aim of the research was to determine to what extent the components of the NSM (that are characteristic for the model) actually have been implemented on the wards. The second aim was to determine the effects of the implementation. The presentation will reveal the effects on six research-variables: knowledge of the NSM, nursing process, client satisfaction, caregiver satisfaction, quality of care and culture on the ward. The research results will provide inside into the quality of the NSM for daily practice. Results show that use of the NSM improves the extent to which nurses apply the nursing process. The concepts of “person” and “health” are better understood and implemented in daily practice. There are also effects on caregiver satisfaction and nurses see more potential differentiation of functions. 

After implementing the NSM, clients are more positive about the received care and nurses have better understanding of patients wishes and questions. Use of the NSM stimulates a more client centered approach of care. Thus, the results of eight years of research show that using the NSM is beneficial for a mental health care organization.



Utilization of the Neuman Systems Model in Case Management of Childhood Lead Poisoning in the Mexican Migrant Population


Kathleen Vito, PhD, RN

University of Pennsylvania

& Cumberland/Salem Health Department (NJ)

Pittsgrove, NJ



            Childhood lead poisoning rates in the United States have decreased over the past three decades since lead was banned as an additive in household paint and gasoline.  However the Center for Disease Control and Prevention (CDC) has not established what is a “safe” blood lead level.  There is no physiological need for lead in the human body. Ingested lead is a significant stressor in young children. Evidence from many research studies indicates that brain damage and other adverse effects are significant and irreversible in children who are asymptomatic. 

            Case management by nurses in public health departments for lead burdened children are part of intervention guidelines recommended by the CDC.  Recent cases have been increasing found to be related to lead sources in the home other than lead paint.  In particular, populations with ethnic origins from Mexico have been identified at risk from folk remedies, herbs, seasonings, canned goods, cooking utensils and candy that is imported from Mexico and sold in the United States or these items are brought back from visits to Mexico. 

            The Neuman Systems Model was utilized for the design of an assessment tool and intervention plan for cases of lead burdened children in a county health department in the mid-Atlantic region.  The population served was 14% Hispanic with Mexican origin.  The sociocultural variable of the assessment was especially valuable in determining sources of lead besides lead paint.  A key component of the assessment was the family’s perception of sources of lead.  Culturally sensitive secondary and tertiary preventions were designed for identified lead burdened children of Mexican origin. Culturally sensitive primary and early secondary preventions at the block level were designed for targeted, at risk neighborhoods where the cases resided.





The NSM and Nursing Faculty Retention: Prevention as Intervention


Pamela Ahlfeld, MS, RN

Barbara James, DSN, RN, CNE

Southern Adventist University

Collegedale, TN



The nursing faculty shortage in the United States is of grave concern to nursing program administrators. The aging of nursing faculty and subsequent retirements poses a serious dilemma. Qualified students are turned away from programs due to this shortage. Attracting nurse educators is difficult. Barriers include higher salaries for clinicians and the demand for doctoral preparation. Once educators are recruited, retention is another challenge for administrators.


The NSM provides a helpful framework in which to view the new nursing educator as client with the departmental dean and nursing colleagues as providers of care. The new educator must cope with stressors in potentially all variables of the client structure. Faculty role ambiguity, lack of experience in classroom teaching, lack of knowledge in how to devise teaching methodology appropriate for 19-year-olds as well as middle-agers, lack of a defined eight or twelve hour work schedule, lower financial remuneration, and numerous other stressors threaten the client core.


Seasoned faculty care providers, through appropriate mentorship, have the opportunity to use primary and secondary interventions to strengthen the flexible line of defense and the lines of resistance and save the new educator from burnout. These interventions include orientation to the faculty role, teaching nuggets at monthly meetings, and provision of professional growth funds. Mentors provide support for the novice professor. Social activities are viewed as enhancing the flexible line of defense. Dinner is served at monthly faculty council meetings. Faculty are invited to participate in regular socials (both with and without families). An annual week-end retreat in the mountains is scheduled. More sophisticated team-building activities have included faculty participation in a ropes course and geocaching experience at the beginning of the academic year.


Prevention as intervention has worked! At SAU’s SON, all positions are filled and turnover has been at a minimum.



Gender Differences in Presenting Symptoms,

Treatment, and Outcome in Myocardial Infarction


Alona D. Angosta, RN, MSN, APN-C
University of Nevada

Las Vegas, NV



In spite of the increase awareness that women’s cardiac conditions are frequently misdiagnosed, women continue to die of MI. The culture of being female may lend itself to differing clinical manifestations and/or treatments for heart disease when compared to men.  The purpose of this study was to investigate the symptoms of MI in women compared to the symptoms, treatment, and outcome for men.


Conceptual Framework: The study utilized the Neuman’s Systems Model because of its wholistic focus. The patient’s lines of defense are disrupted by presenting symptoms of MI as this condition is a stressor that can cause system instability. Prompt recognition of symptoms and the initiation of early treatment help stabilize the patient’s lines of defense, which in turn helps the patient to regain optimum wellness and stability.


Methodology: A retrospective comparative descriptive research design was utilized to study a sample  of 300 patients (N=150 men, N=150 women) diagnosed with an  MI in a county hospital in Las Vegas.  IRB approval was obtained from the University of Nevada, Las Vegas. Chart review was utilized to collect data over a period of 3 months.


Results & Discussion of Findings: Chest pain, shortness of breath, sweating, and left arm pain were the most common symptoms reported by both genders. Men had more chest pain than women (p.022) as well as more Q wave changes during MI than women (p=.019). Women suffer MI two and a half years later than men (p=.004). Oxygen, nitrates, morphine sulfate, and heparin were the most common treatments given to men and women, however, men received more morphine sulfate (p=.013) and beta blockers (p=.011) than women in the emergency department. No significant differences were found in diagnostic and therapeutic procedures for men or women and outcomes were also similar for both genders.


Implications: Nurses’ knowledge regarding the different symptomatology, treatment and outcome for MIs in men compared to women can affect the gender specific care given. Nurses should recognize the symptoms of MI as a stressor to the patient’s lines of defense, which can provide early interventions to help stabilize patients and perhaps reduce mortality.  Additionally, patient should be educated about gender differences of presenting symptoms, treatment, and outcome of MI to help decrease mortality in women by strengthening their normal lines of defense.  



Student Nurses’ Concepts of Spirituality and Influence on Nursing Practice


Sarah Beckman, MSN, RN
Sanna Boxley-Harges, MA, RN
Cheryl Bruick-Sorge, MA, RN

Becky Salmon, MS, RN

Purdue University @ Ft. Wayne

Ft. Wayne, IN



            Spirituality is an integral component of a person’s wholeness that carries implications throughout one’s life.  Spirituality has different meanings to different individuals with minimal definitions documented in academe.  A review of the literature indicates that students do not feel adequately prepared to address their client’s spiritual needs.  Studies indicate there is a dichotomy between the expectations of education and the reality of nursing practice.  McSherry (2000) reports that as students become more educated about spirituality, they are better able to identify and use spiritual interventions in their practice setting.

This paper discusses a qualitative research study in progress to measure student nurses’ concepts of spirituality.  Preliminary findings examine the evolution in students’ definition of spirituality throughout this Neuman-based nursing program.  Triangulation methodology will be discussed briefly with a report on themes identified in student responses.   Nursing care in response to identified spiritual needs evidenced in the nursing care plans will be presented.  Projections by the researchers on impact for ongoing and future research initiatives will be shared. 



The Neuman Systems Model Applied to Victimology


Barbara Scott Cammuso PhD, EdD, APRN, BC

Fitchburg State College

Shrewsbury, MA



             The definitions for the term victim changed gradually over time. Currently, the word victim has been defined as an individual, family, group, or community who suffers physical, psychological, or financial harm from an oppressor. According to O’Connor (2004), victimology is the scientific study of victimization, which includes the relationships between victims and offenders, the interactions between victims and the criminal justice system, and the connections between victims and other societal groups and institutions. Karmen (2001) suggests the inclusion of the following concerns: the victim’s physical, emotional, social, and economical welfare as well as victim assistance, rehabilitation, education, and empowerment. The desire to assist the victim continues to gain momentum

            The Neuman Systems Model views clients as systems in constant interaction with their internal, external and created environments. It is a comprehensive, practical model that provides health care personnel direction for assessment and intervention. The five interacting variables and preventions as interventions provide a useful framework for professionals working with victims of violence in all health care settings.

         Nursing is a humanistic profession and as such will encounter victims suffering from various crimes. The author  will present statistics, a quick synopsis of the types of victims, risk factors, assessment, documentation and related primary, secondary, and tertiary prevention as interventions. There is a need to conduct research studies for the purpose of recognizing the precipitating factors of violence and determining the effectiveness of interventions in order to arrest its progress.



Karmen, A. (2001). Crime victims: An introduction to victimology. (4th ed). Australia: Wadsworth Thompson Learning.

O’Connor, T. The study of victimology. Retrieved January 23, 2004 from



Education on Insulin Resistance and the Insulin Resistance Syndrome:

A Study Evaluating the Short Term Impact of a

Group Program Targeting Those at Risk


Brenda M. Cupp RNC MSN

Carterville, MO



The purpose of the study was to determine if a group based educational program would enhance the attendees knowledge on the topic of insulin resistance and the insulin resistance syndrome.  This was a quantitative study research design utilizing a pre-test and post-test evaluation.  The study evaluated whether a group who is at an increased risk of the development of diabetes (between the ages of 20-49), and/or healthcare providers who care for those at risk for insulin resistance are: able to identify the risk factors for the development of insulin resistance and identify the components of the Insulin Resistance Syndrome (IRS); able to increase their knowledge base about the disease process and potential complications of IRS while attending a group based educational program; and, able to identify specific preventative measures as a result of this knowledge.


A sub-set of people known as “insulin resistant” or “pre diabetic” are at risk for the development of diabetes.  This condition and the compilation of abnormalities that formulate the syndrome of insulin resistance, have identifiable risk factor(s) leading to the development of type 2 diabetes, cardiovascular disease, and various other medical complexes.  It is reported that insulin resistance syndrome (IRS) affects 1 in 3 to 4 adults over the age of 20.


The conceptual framework utilized for the study was the Neuman Systems Model.  The researcher selected this model as it best depicts the spectrum of care involved in managing those affected by chronic diseases. 


This research study as well as previous studies confirms that knowledge is gained utilizing a target driven approach.  Regardless of prior knowledge, age, or personal risk factors, there was statistically significant knowledge gained (p = <0.05) on the research questions tested.  Disease retardation and decreased health care costs related to various disease complications are promising utilizing this approach. 



Incidence of the Use of Barrier Methods During Oral Sex


Theresa G. Lawson, MS, APRN, BC, FNP

Lander University

Greenwood, SC



            For various reasons, oral sex is becoming increasingly popular among adolescents and young adults. Despite this increase in popularity, there appears to be little increase in educational programming targeting this behavior. The primary objective of this study was to determine the incidence of the use of barrier methods during oral sex among college students. After obtaining Institutional Review Board approval, a Web-based survey was sent to the student body of a small public university to evaluate health promotion practices during oral sex. A significant number of students reported engaging in oral sex with multiple partners, while fewer reported the use of barrier methods during this activity. These findings highlight the need for educating young adults about the risks associated with unprotected oral sex.

The Neuman Systems Model provided the conceptual framework for the study. The client is the individual engaging in oral sex, while the activity itself may be a stressor. Oral sex can be both an intrapersonal and an interpersonal stressor, as the risk for contracting Sexually Transmitted Infection from oral sex is present. It may be an extrapersonal stressor as well, in light of societal trends and minimal education about the issue. This presentation will discuss the topic of oral sex among young adults and will help nurses to better understand this issue in order to meet the challenges in educating this population.



Adolescent Tobacco Prevention


Heather Saifman, RN, BSN, CCRN

Nova Southeastern University

Cooper City, FL



The national health objective publication, Healthy People 2010, has identified the prevention of adolescent smoking as one of the nation’s most preventable health threats.  Guidelines have been established to aid the nation in an effort to reduce the threats to public health by reducing the rates of adolescent smoking (Centers for Disease Control, 2004).

The Partners in Prevention of Substance Abuse (PIPSA) is a statewide project created in conjunction with the Florida Department of Health (DOH) to address the important issue of tobacco use among adolescents.  In an ongoing effort to provide primary prevention education to the adolescent, the PIPSA program combined efforts with the Area Health Education Center (AHEC) Nova Southeastern University (NSU) Health Professions Division Tobacco Prevention and Cessation Program.  Under the supervision of NSU nursing faculty, approximately 24 entry-level Bachelor of Science in Nursing (BSN) students and 12 practicing registered nurses (RN) currently pursuing a BSN degree participated in cooperative learning activities to prepare them to provide education about the effects of tobacco use to Florida’s elementary school students.   These practitioners participated in comprehensive activities that combine didactic teaching methods, lectures and Patient-Oriented Problem Solving modules (POPS) in order to prepare them to present this valuable prevention information to fifth grade elementary school students across Florida.

This program offers thousands of elementary school students across Florida access to health education on tobacco.  The strength of this program is in its ability to provide the student a valuable education in a fun learning environment while training the health care professional in effective ways to work with the community’s pediatric population; in a multi faceted, statewide effort to prevent and reduce the adolescent use of tobacco.



Centers for Disease Control. (2004). Cigarette use among high school students-United States, 1991-2003. Morbidity and Mortality Weekly Report, 53(23), 499-502.



The NSM Experience


Robbie South, MSN, APRN, BC, CS

Lander University

Greenwood, SC


            Purpose: Nursing students in their first semester of study often have difficulty grasping the concepts related to the nursing process and a client assessment. Clinical assignments are primarily laboratory experiences and students have limited opportunities to interact with “real patients”. Students can identify the various client variables included in an assessment and practice the steps of the nursing process in group activities using nursing rhyme characters as “patients”.

            Conceptual Framework: The Neuman Systems Model is used to provide a framework for the assessment of clients. Students are taught to assess the five client variables as they work with their nursery rhyme characters.

            Methodology: Students are assigned various nursery rhyme characters and are instructed to provide an assessment, to identify the client problem, and to record the nursing diagnosis. Although limited in their understanding of interventions, students follow the sequence of the nursing process, using their imaginations to fill in the gaps of the nursery rhyme. A worksheet guides the student through the assignment and is used to document the student’s findings.

            Results: Students are able to learn important concepts related to assessment, client variables, and the nursing process in a non-threatening, light-hearted group activity. Using the nursing rhyme characters helps students retain the information learned from the class assignment.

            Discussion and Implications: Innovative teaching methods are needed to communicate important content in nursing education programs. Light-hearted, fun methods of presenting material could help to decrease the stress level of nursing students and provide an environment conducive to learning. Providing a familiar “patient” for the first semester nursing student enhances the learning experience.



A Structured Application of the Neuman Systems Model: A Pilot Study


Rilla Taylor, EdD, MN, BSNE, RN

Florida Hospital College of Health Sciences

Sarasota, FL




            Graduate students, who have at least one class in theory, grasp and apply the Neuman Systems Model easily and AS students who are taught on a Neuman-based curriculum become familiar with its concepts.  However, the RN returning to complete a B.S. has unique problems.

The RNs have well established personal modes of practice that reflect years of experience, their own personalities, and a variety of basic nursing program approaches.  Given the limited curricular time for theory, and the RN’s typical concrete thought style, there is a need for a teaching mechanism that allows the RN pre-BS student to begin applying the major concepts of  the model rapidly.  Only thus will the RN experience benefits from the use of theory in the “real world.”   As he/she progresses through the program, deeper understanding will develop.



            The purpose of the project is to pilot a teaching tool that, with limited academic preparation, allows an pre-BS experienced RN to promptly experience benefit in applying the Neuman Systems Model in a clinical setting,


Conceptual Framework

            Within the limited time a BS completion program allows, the student either gains a positive experience with theory and is intrigued to study more, or gains a negative experience with theory and decides it is irrelevant.  A simple tool can guide a nurse’s first efforts and provide a positive experience as he/she relates nursing theory to clinical practice.



            The writer has designed a guide which traces the steps of a nurse’s thought as he/she approaches the patient from a Neuman Systems Model framework, and will pilot it with at least 75 incoming BS completion RN students during the Fall Term, 2006.   Students’ opinions regarding the usefulness of model will be surveyed, themes summarized and short answers reported using descriptive statistics (aggregated).


Discussion and Implications

After the findings are gathered, discussion and implications will follow.