Introduction
Nursing theories have a significant influence on nursing practice as they allow not only set the goals and extract the theoretical value but define the outcomes and retrieve practical use. Two types of theories can be identified within the framework of nursing: Grand theories and Middle Range theories. Researchers state that Grand theories are more complex used to explain the broadest issues within the discipline and are not subjected to testing and amendments (McEwen & Wills, 2014).
Meanwhile, Middle theories lie in between abstract theories and concise ones and represent more specific ideas and concepts, and can be empirically tested (Alligood, 2013). The purpose of this paper is to investigate and compare The Neuman System’s Model and Braden’s Self-help theory. Neuman’s Grand theory represents a systemic approach towards relieving stress and the human necessity of protection. In contrast, Braden’s Middle theory describes the facets that have a negative and positive effect on one’s quality of life.
Background of the Theories
Betty Neuman is a pioneer in the field of nursing, specifically in the sphere of mental health investigations, since the 1960s. She created her model, which was developed over time, and published it in 1972, and since then, her model was widely used in nursing colleges not only in the United States but also across the world. The concept of her theory is aimed towards the systemic approach to stress relief and the human need for protection.
According to McEwen and Wills (2014), “Neuman believed that the causes of stress could be identified and remedied through nursing interventions” (p.150). She highlighted the dynamic balance that is crucial for humans and used a method of intervention as a way of prevention. Neuman’s model is considered perspective as it is abstract, universal, and have a wide range of appliance for any human of a different culture.
Carrie Jo Braden is a professor at the School of Nursing in Texas, famous for her publications about the five-stage Self-Help Model. This theory concerns the promotion of independent functioning, self-reliance, improvement of the psychosocial wellbeing of a patient with the help of nursing intervention (Chuang, Lin, & Gau, 2010). The method is based on the research that deals with learning how to learn to respond to chronic illness and understand the dynamics of the reaction learned. Nevertheless, there is a need to perceive the dynamics of this learned response because sometimes it depends on a personal trial. A learned response presumes a procedure of daily facing manageable adversities by retaining control over the problems. Comprehending the process of self-responding implies the introduction of nursing interventions to increase the efficacy of learning for a person with chronic illness. Therefore, enhancing self-behavior by the intrusion of disruptive forces increases the life quality.
Philosophical Underpinnings
Betty Neuman underpinned the theories and concepts derived from different disciplines to develop her approach. She preferred to extract the ideas from the theories of many other researchers. For instance, Neuman borrowed the wholeness of systems referring to Cornu and Chardin. Also, she referred to Lazarus on general systems theory, Skye on stress theory, and Bertalanfy and Lazlo on public systems theory (McEwen & Wills, 2014).
Carrie Jo Braden relied on the theories contrastive to her Self-Help Model. Her theory emerged from a couple of learned helplessness theories belonging to Seligman and Balta, Rosenbaum’s learned resourcefulness theory, and the method of personal disposition proposed by Miller and Magon (Chuang et al., 2010). She also applied background variables such as age, gender, ethnicity, education, and income that could influence the skill of developing self-response.
Major Assumptions, Concepts, and Relationships
Neuman followed the concepts of the metaparadigm, though managed to introduce additional concepts to her model. There are some major concepts of her theory that she presented: a human is “a client/client system, as a composite of variables… physiological, psychological, sociocultural, developmental, and spiritual” (Neuman & Fawcett, 2009, p. 16). Her ring structure was presented as a “basic structure of protective concentric rings, for retention attainment or maintenance of system stability and integrity…” (Neuman & Fawcett, 2009, p. 16).
The environment presented a structure of such rings and was divided into three parts: created, internal, and external environments that affect a human’s perception of stressors. Health presupposes stability, which can be ruined by several stressors. The nursing concern is to adequately assess the environmental conditions and stressors that affect wellness instability and assist the client in maintaining optimal wellness (McEwen & Wills, 2014). Therefore, numerous concepts are comprising Neuman’s System Model.
Another primary concept introduced by Neuman is an open system that represents a flow of input and output that are interactional processes of organized complexity. The next idea is a basic structure that is the unique individual characteristic underlying the basic system of energy resources. Client variables that belong to the different processes and network within human nature. She also defined a flexible line of defense as “A protective, accordion-like mechanism that surrounds and protects the normal line of defense from invasion by stressors” (McEwen & Wills, 2014, p.151). Moreover, Neuman added healthy life of defense that is a level of health considered normal for an individual and for determining deviant wellness features. The other concept is the line of resistance, which activates when the stressors penetrate the normal line.
The five variables (sociocultural, physiologic, physiologic, spiritual, and developmental) that Neuman defined function to maintain the system’s stability. The model is based on the client’s reaction to stress as it maintains boundaries to protect client stability (Neuman & Fawcett, 2009). Her model described a three-step program: nursing analysis, nursing goals, and nursing outcomes. The first step is a nursing analysis that represents an adequate collecting database from the client that assists in making a diagnosis. The second step, nursing goals, concerns appropriate prevention as a strategy of intervention. Also, this step presupposes purposeful negotiation with the client. Finally, the nursing outcomes, that assume the evaluation of nursing goals and changes prescribed. The nurse tries to link variables, the client, his health, and the environment.
There is a need to mention the assumptions of Neuman’s System Model. The first assumption is that “Each client system is unique, a composite of factors and characteristics within a given range of responses” (McEwen & Wills, 2014, p.153). According to Alligood (2013), the other primary supposition concerns stressors and how they are different. Three lines work altogether to sustain the health of a client. Therefore, when a client or system’s flexible line is broken, the stressors also ruin the normal line. Also, the client represents a dynamic system consisting of interdependent variables that are also interrelated with the environment.
Braden’s Self-Help theory also includes some of the significant concepts belonging to the Middle Range nursing theories. Usually, such approaches consist of two or more of the specific interrelated concepts and address the phenomena describing the metaparadigm at one end and particular actions at the other. The first concept in Braden’s model is disease characteristics, which is the degree of the illness’s effect on a patient’s behavior. The second concept is background characteristics that include gender, age, origin, and all the inducements that influenced current behavior. Monitoring is another aspect that represents the measurement of illness provided by professionals.
The severity of illness is a level of causation inflicted by the disease; dependency represents the level of reliance on other people while performing daily activities. Uncertainty is the next concept implying incapacity to identify the meaning of illness events; enabling skills is a level of self-reliance, problem-solving; self-help is defined by a degree of adult behavior. The last concept is life quality that denotes the level of satisfaction of the present situation.
The relationships in this five-stage model are represented in the following way. Stage I shows the severity of illness that is a stimulus for learning. At Stage II, uncertainty and dependency occur due to the increase of severity of illness: therefore, the levels of uncertainty and dependence also rise. Uncertainty can arise when there are symptoms not related to the disease emerge, whereas dependency appears when one perceives the severity of illness and ends up relying on others. At stage III, the concept of enabling skills appears as an agent between negative aspects and maintaining life quality. Skills enabling is usually is undermined by previous thoughts but is essential for problem-solving and learning personal strengths to sustain one’s life. The last two stages include desirable life quality and preferable outputs of self-help. It denotes that one must realize what essential in life for maintaining the life level that they want.
The first assumption concerns perceiving the severity of illness, leading to uncertainty and limitations. Another primary assumption of Braden’s theory supposes that adversities can be overcome by enabling skills and learned resourcefulness. These skills represent sets of behavior, affects, and cognition that interacts with the environment. Also, self-help is about maintaining relationships with friends, family, colleagues at any place that leads to satisfaction, which is a fundamental pursuit of health care.
Clinical Application
Neuman’s theory is widely used among nursing professionals worldwide. This model is applied to many areas of medicine, including surgery, mental health, women’s health, gerontology. Many graduate students find Neuman System Model relevant to their practice. “Because of its utility and popularity as a model, it has been monitored by a group called the Neuman Systems Model Trustees Group, Inc. (McEwen & Wills, 2014, p.153).
According to Chuang et al. (2010), “The Braden Self-Help Model has previously been applied to patients with rheumatoid arthritis, chronic pain, breast cancer, heart failure, and HIV or AIDS” (p.207). This model is also used among sociologists and health scholars investigating the relationship between healthcare and psychological factors and believe that patients with chronic illness should focus on enabling abilities to lead a safe life.
Application to Nursing Practice
According to McEwen and Wills (2014), “The Neuman Systems Model has extended nursing science as a needs and causality-focused framework” (p.154). It means that this model is appealing to the nurses who view their patients as coherent individuals reacting to stressors. Neuman’s model is useful as a base that sees prevention as intervention, and because it focuses on maintaining system stability. Also, the model helps to identify stressors and eliminate them. Though the theory is not testable fully, some aspects of it are tested, so it is widely used as a conceptual framework within the nursing practice (McEwen & Wills, 2014).
Braden’s theory appeals to the nurses who interfere intending to help the patient to face the severity of illness, overcome dependency and uncertainty, and develop skills for understanding the importance of treatment. This approach provides care with nonmedical treatment, allowing to alleviate the symptoms and learn to self-respond. The model proves to be testable as many works were dedicated to testing this approach.
Application to My Practice
I perceive the Neuman Systems Model as multi-applicable in nursing practice. When a patient is admitted to the hospital because of stressful disorders such as anxiety, sexual, sleeping, or an eating disorder, the nurse can assist him by intervening as well. Firstly, the nurse should identify the environment of the stressors that can be psychological, physiological, socio-cultural, and spiritual. After that, the assessment is carried out, and the nurse decides what sort of intervention to practice. By setting the goals, the nurse esteems presumable outcomes, centers on a client’s needs and activities, and starts the prevention as an intervention. There are three types of prevention I can use in my practice that eventually lead to re-adaptation and recovering patients’ health.
My perception of the Braden Self-Help model is directed towards treating patients with chronic illnesses or cancer. A nurse should be able to measure the severity of a client’s pain, level of uncertainty, and dependency. The nurse intervention should be slight as the goal of treatment concerns the patient’s understanding and learning self-response. The client’s ability to comprehend the opportunity of better life quality enables them to control everyday activities. So, the nurse must intervene mostly with nonmedical means but with psychological means that enable the patient’s skills. I can learn the pattern of such interventions for providing psychological help.
Parsimony
The Model developed by Neuman is complex because the concepts and functions it suggests can be used in multiple ways. Therefore, the model is a bit confusing and cannot be called parsimonious. Though some diagrams prove to be efficient in understanding. The definitions are concise, and the assumptions are well developed.
Braden’s perspective is not as complex as the abovementioned theory as it constitutes clear concepts.
Conclusion
Comparing the Neuman Systems Model and Braden Self-Help model, it is necessary to state that they are unlikely to be compared. The Grand Neuman’s perspective is more complex and comprises some abstract concepts that are hard to comprehend. This theory implies treating patients affected by stressors with prevention as a way of intervention. The Middle Braden’s methods include more concrete concepts and guided towards enabling skills of the patients suffering from chronic illnesses to qualify for better life circumstances.
References
Alligood, M. R. (2013). Nursing theory-e-book: Utilization & application. Elsevier Health Sciences.
Chuang, T.-H., Lin, K.-C., & Gau, M.-L. (2010). Validation of the Braden self-help model in women with systemic lupus erythematosus. Journal of Nursing Research, 18(3), 206–214.
McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Neuman, B., & Fawcett, J. (2009). The Neuman systems model (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.