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288 UNIT III Nursing Conceptual Models

The ongoing development and universal appeal of the three prevention-as-intervention modes. Eval-
of the model are reflected in the international uation then is used to confirm that the desired out-
Biennial Neuman Systems Model Symposia, which comes have been achieved or to reformulate the goals
provide a forum across cultures for practitioners, or outcomes. Neuman (2011a) outlines her nursing
educators, researchers, and students to share informa- process format, clarifying the steps in the process
tion about their use of the model. The first sympo- for use of her model in Appendix C (pp. 338–350).
sium was held in 1986 at Neumann College in Aston, Russell (2002) provides a review of clinical tools using
Pennsylvania. Subsequent symposia have been held in the model to guide nursing practice with individuals,
Kansas City, Missouri (1988); Dayton, Ohio (1990); families, communities, and organizations.
Rochester, New York (1993); Orlando, Florida (1995); The breadth of the Neuman model has resulted in
Boston, Massachusetts (1997); Vancouver, British its application and adaptation in a variety of nursing
Columbia (1999); Salt Lake City, Utah (2001); Willow practice settings, including hospitals, nursing homes,
Grove, Pennsylvania (2003); Akron, Ohio (2005); rehabilitation centers, hospices, mental health units,
Ft. Lauderdale, Florida (2007); Las Vegas, NV (2009); childbirth centers, and community-based services
and Allentown, PA (2011). Each symposium has such as congregational nurse practices. Numerous
attracted participation from countries throughout examples are cited in Neuman’s books (1982, 1989,
the world and from disciplines beyond nursing. 1995, 2002b, 2011). The model’s wholistic approach
makes it particularly applicable for clients who are
Practice experiencing complex stressors that affect multiple
Use of the Neuman Systems Model for nursing client variables such as terminal liver cancer (Hsuan,
practice facilitates goal-directed, unified, wholistic 2009).The model has been used to guide nursing
approaches to client care, yet the model is also ap- practice in countries throughout the world. As an
propriate for multidisciplinary use to prevent frag- example, it is used in Holland to guide Emergis,
mentation of client care. The model delineates a a comprehensive program of mental health that
client system and classification of stressors that can provides psychiatric care for children, adolescents,
be understood and used by all members of the adults, and elderly, and addiction care and social ser-
health care team (Mirenda, 1986). Guidelines have vices (Merks, van Tilburg, & Lowry, 2011; Munck &
been published for use of the model in clinical nurs- Merks, 2002).
ing practice (Freese, Russell, Neuman, & Fawcett, Neuman’s model provides a systems perspective for
2011) and for the administration of health care ser- use with individuals and families, for community-
vices (Shambaugh, Neuman, & Fawcett, 2011). based practice with groups, and in public health nurs-
Several instruments have been published to facilitate ing, as its wholistic principles assist nurses to achieve
use of the model. These instruments include an assess- high-quality care through evidence-based practices
ment and intervention tool to assist nurses in collecting (Ume-Nwagbo, Dewan, & Lowry, 2006). Anderson,
and synthesizing client data, a format for prevention as McFarland, and Helton (1986) used the model for a
intervention, and a format for application of the nursing community health needs assessment in which they
process within the framework of the Neuman Systems identified violence toward women as a major commu-
Model (Neuman 2011a; Russell, 2002). nity health concern. This model has been used to guide
The Neuman Nursing Process Format consists of pediatric nursing practice (Spurr, Bally, Ogenchuk,
three steps: (1) nursing diagnosis, (2) nursing goals, et al., 2011) and as a framework for advanced psychiat-
and (3) nursing outcomes. (When used by other dis- ric nursing practice (Groesbeck, 2011).
ciplines, the term nursing is changed accordingly.) Likewise, the model is functional in the acute care
Diagnosis involves obtaining a broad, comprehensive setting. For example, Allegiance Health in Michigan
data base from which variances from wellness can adopted the Neuman Systems Model to be imple-
be determined. Goals are established by negotiation mented as the nursing conceptual model at their
between client and caregiver for desired prescriptive institution. As part of the implementation process,
changes to correct variances from wellness. Outcomes various documents were revised or created to reflect
are established in relation to the goal for one or more nursing care using concepts of the model, such as the