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Neuman Systems Model International Symposium 2011 Abstracts Abstracts for Plenary Sessions Education Plenary Evidence-Based Nursing Education – Reality or Created Environment?
Sanna Boxley-Harges RN, MA Associate Professor Indiana University-Purdue University Fort Wayne Fort Wayne, Indiana USA
Anna M Helewka RPN, RN, MSN Faculty and Curriculum Coordinator Faculty of Health Sciences, Department of Psychiatric Nursing, Douglas College, Coquitlam Campus British Columbia Canada
Assumptions prevail that nursing education is evidenced based. These assumptions are based on the fact that nursing practice is rooted in scientific inquiry ensuing that nursing education curricula which is based on this body of knowledge is also evidenced based—it would logically follow then that nursing education processes are also evidence based. However, it can be argued that although nurse educators are adept at creating learning environments through the development of curricula and teaching/learning strategies—much of this body of knowledge can be described as the art of teaching in that it is often implicit, pragmatic and based upon practice. Nursing education has been so focused on the science of nursing practice that the science of nursing education has been somewhat neglected. Rigorous qualitative and quantitative research is needed to develop the science of nursing education. The use of the Neuman Systems Model in nursing education programs provides nurse educators with many opportunities to conduct research into the dynamics of teaching and learning processes for nursing students. Nurse educators using the Neuman Systems Model for Nursing often need to develop strategies, curricular designs and frameworks for effective teaching and practice of the NSM—both for students and faculty. Applying the principles of scientific principles to the development of teaching strategies, program designs and curriculum frameworks will serve to advance science of nursing education and further contribute to the profession of nursing.
Sanna Boxley-Harges and Anna M Helewka are nurse educators utilizing the Neuman Systems Model for Nursing in their respective nursing programs. The focus of the plenary will be to describe their experiences as educators in adapting to and teaching the NSM in their programs—journeys that although exciting have at times also been quite agonizing. Sanna and Anna will also explicate the opportunities for future research in nursing education based on their use of the NSM. Practice Plenary
Use of the Neuman Systems Model for Evidence-Based Practice …both in the United States and in Holland
Diane Breckenridge, PhD, MSN, RN Associate Professor, La Salle University Philadelphia, Pennsylvania & Nursing Research Director, Abington Memorial Hospital – Magnet Designated Abington, Pennsylvania USA
The purpose of the Practice Plenary is to present the use of the Neuman Systems Model in Evidence-based Practice both in the United States and in Holland. This Plenary will be presented with an overview of the Neuman Systems Model Practice Institute with Holland Trustee, Andre Merks. During this Plenary, Andre Merks and Marlou du Kuiper, both Trustees, would be introduced to give: Application to Practice: Holland Style. The time frame would be split in which Breckenridge would give the following:
Practice Plenary
Neuman Systems Model Theory-Guided Evidence-Based Practice: A Health Care Focus. This Health Care Focus (Figure 1) developed by Breckenridge in Neuman and later in Neuman and Fawcett; was originally printed in the first Neuman Systems Model book in 1982 and subsequent books, 1989, 1995, and 2002 and most recently in 2011. The Health Care Focus depicts prevention interventions of primary, secondary, and tertiary levels of care with the client at the center of care. Today, health care systems, especially inpatient hospital settings, are experiencing decreases in hospital census. The utility of this circular depiction is helpful as more patients are transitioning from the acute care settings into outpatient long-term settings as health care reform is striving for less costly alternatives. Today, this paradigm of the Health Care Focus is still relevant and applicable (Figure 2, 3, 4 and 5). Also, the medical–nursing paradigm by Breckenridge in Neuman (1989;1995) has evolved as a template today to determine inpatient and outpatient service lines in Gerontology and other health care services, headed up by a nurse and physician team. This is similar to the Clinical Practice Guideline template that Ada Jacox, PhD, RN, FAAN, from John Hopkins Medical Center and the University of Maryland developed for the Acute Pain Clinical Practice Guideline from the NIH. Breckenridge was mentored to also develop Nephrology Clinical Practice Guidelines based on the Neuman Systems Model with the client at the center of care from this approach. Today, the Complementary Therapies, Gerontology, and NICU service lines have replicated this process based on the Neuman Systems Model. Therefore, this presentation related to the United States Health Care Focus will give four examples: Complementary Therapies by Sue Kristiniak, RN, MSN, DHA©; the Gerontology Service Line by Kim Shields, RN, MSN; and Stressors Experienced by NICU Parents by Cindy Grosik, RN, MSN, CNL; and Promoting Civility by Prevention Interventions in Practice Environments by Breckenridge, PhD, RN and Clark, PhD, RN, ANEF. These programs have been cited in the 4th Edition of the Neuman Systems Model book under the evidence-based practice program of RAIN: Research Approach in Nursing by Breckenridge. They have also been submitted as publications related to practice implementation to ANS, NSQ, and the Holistic Journal, as well as, one dissertation.
Participant Outcomes:
1. The Participant will be able to describe the components of a NSM Theory-Guided Evidence-based nursing practice program. 2. The Participant will be able to describe the application to practice related to differences between the US and Holland Health Care Focus of care systems.
Research Plenary
A New Look at Conceptual and Empirical Considerations When Using the NSM as a Research Model
Eileen Gigliotti RN; PhD Professor, City University of New York College of Staten Island and The Graduate Center Staten Island, New York USA
Over 10 years ago, Gigliotti (1999) published a paper concerning the conceptual and empirical considerations to be made when using Neuman’s lines of defense and resistance in quantitative research studies. Since that time, new insights resulting from Gigliotti’s (2007), Gehrling’s (2009) and Partlak-Gunusen, Ustun and Gigliotti’s (2009) work have called some of these proposals into question. This paper provides a brief overview of Gigliotti’s (1999) proposals, and then offers a revised proposal including the following: 1. Flexible Line of Defense: Consideration of the flexible line of defense as “interacting variables” necessitates use of statistical tests of interaction which require extremely large samples. In light of Gigliotti’s (2007) work, it is now proposed that flexible line of defense variables be considered “working together” and use of hierarchical multiple regression can test for the relations between stressors, the flexible line of defense and the normal line of defense. 2. Lines of Resistance: The formerly proposed (recursive), strict linear relation between the normal line of defense, the lines of resistance and the core requires use of a mediated model. Though this is still recommended, the proposed ability of the lines of resistance to move the client back towards a state of wellness (normal line of defense) and Gehrling’s (2009) work concerning reconstitution has led to a new proposition. That is, the relation can also be non recursive, moving the client back towards wellness. 3. Core Response: The core response was formerly considered an endpoint. However, in light of Partlak-Gunusen, Ustun, and Gigliotti’s (2009) work, the core response can be the beginning of reconstitution as the client perceives the need for change and moves back towards wellness. Thus the core response can be considered an independent as well as a dependent variable. This paper makes use of practical examples to explain the new propositions.
Participant Outcomes: At the completion of this presentation the attendee will be able to: 1. Explain the formerly proposed conceptual and empirical considerations 2. Explain the newly proposed conceptual and empirical considerations
Abstracts for Paper Presentations Meeting the Challenge of Teaching the Millennial Nursing Student in a Neuman-based Program
Cheryl Bruick-Sorge, MA, RN Becky Salmon, MS, RN, CCRN Associate Professors of Nursing Indiana University-Purdue University Fort Wayne Fort Wayne, Indiana USA
Do your students seem bored and preoccupied? Are you struggling to effectively meet their learning needs? Millennial students enter college with unique characteristics that differ from past generations. They often have short attentions spans and lack effective critical thinking, introspection, and face-to-face communication skills. (Wilson, 2005) Although these students are exposed to vast amounts of information more than in previous generations, they have difficulty processing this information with any depth. Millennial students are high stressed, high achievers, and high tech. They also can be characterized as hard working, practical, motivated, and good at multi-tasking. (DeBard, 2004; Knofla, 2007)
Although Millennial students bring their own special challenges to the classroom, faculty has found them enthusiastic and hard working learners. (Gleason, 2008) Research suggests that courses should be designed with clearly written rules, requirements, and grading rubrics. (Elam, Gibson, & Stratton, 2007) A major focus for the teacher must be to hold this students’ interest throughout the learning process. Increased use of active learning, such as case scenarios, video clips, simulations, and real-life situations, has been effective in presenting information face-to-face and on-line that is stimulating, relevant, and applicable. Team learning in the classroom and laboratory setting stimulates cooperation and collaboration. Research also indicates group testing and peer review are effective assessments for this type of learner. (Elam et al.)
Various teaching strategies will be demonstrated including use of real-life scenarios and video clips with audience participation. Classroom assessment that is Neuman-based using case scenarios, simulation, and applied questioning will also be presented using the participants in group testing and peer review. Results of in-class surveys on the outcomes of various active learning strategies will be presented and discussed.
In summary, this presentation will discuss and demonstrate teaching strategies and assessments that have been used successfully to meet the learning needs of the Millennial nursing student in a Neuman-based program.
Participants will 1. Recognize the unique learning needs of the millennial college student. 2. Identify effective teaching strategies used with the Millennial nursing student in a Neuman-based program. The Neuman Systems Model: Critical Thinking and the Learner in Nursing Education
Opal A. Freiburger, Ed.D., R.N. Professor Emerita of Nursing Indiana University-Purdue University Fort Wayne Ossian, Indiana USA
The purpose of this presentation is to explore critical thinking within the nurse-learner environment based upon the NSM. In terms of diversity and applicability, Neuman’s theoretical framework is widely used in nursing, research, clinical practice, and administration. The client system is often described as a family, a group, or a community; however, in this presentation the client system is considered to be a nurse-learner.
Thinking critically is an expectation with legal and ethical implications for the nurse. Frequently asked questions arise. What exactly is critical thinking? What strategies can nurse educators implement to teach critical thinking? In addition to addressing these key questions, the role of the nurse educator will be discussed. For instance, learning opportunities can be structured to encourage students to learn to use inner directed sources of knowledge rather than relying on others to, “Tell me what I need to know.”
Within the Neuman Systems Model the individual student is viewed as a nurse-learner system. As students apply and internalize concepts of the Neuman Model, they gain insight into the process of learning. Students often find that identifying stressors that have a negative impact on learning, and taking actions to strengthen their flexible line of defense, is extremely helpful. Numerous opportunities to promote critical thinking, the Neuman Systems Model, and the learning process are available within the nursing profession.
Examples of strategies and tools to facilitate integration of the Neuman Systems Model, critical thinking, and the learning process will be discussed. Nursing faculty is encouraged to include application of the nurse-learner system as described in this presentation in their course outlines, lecture materials, and teaching manuals.
Objectives: 1. Describe aspects for thinking critically and major concepts of a nurse-learner system that is based within the context of the Neuman Systems Model. 2. Discuss nursing education strategies that foster critical thinking and incorporate the use of a nurse-learner system that is based on the Neuman Systems Model.
Shift Worked, Quality of Sleep, and Elevated Body Mass Index in Nurses Jennifer Huth BSN, RN, Staff Nurse Colleen Handwork BSN, RN, Staff Nurse Jennifer Messenger BSN, RN, Staff Nurse Akron Children’s Hospital Akron, Ohio & Jennifer Englehart BSN, RN, Staff Nurse Aultman Hospital Canton, Ohio USA
The Neuman Systems Model (NSM) provided the framework in examining whether a correlation exists between shift worked, quality of sleep, and elevated body mass index (BMI) in nurses using a descriptive quantitative correlational research design. The client system is the nurse participant. Investigators analyzed the perceived quality of sleep for a relationship to self- reported BMI as evidence of the client system’s response to intrapersonal stress on the line of defense. The physiological and psychological variables described in the NSM were applied in examining the relationship between the external environment of shift worked and the nurses’ internal environment of quality of sleep and the effectiveness of the nurses’ lines of defense measured as BMI. Using the Dillman Tailored Design Method, electronic surveys were distributed to a purposive convenience sample of 1414 licensed nurses. Demographic data gathered included age, gender, level of nursing education, hours and shift worked, and self-reported height and weight. The Pittsburgh Quality of Sleep Index (PQSI) measured sleep quality. The difference between the means for elevated BMI in night shift and day shift is not statistically significant (t = 0.904, df = 367, p > 0.05). There was no statistically significant correlation between elevated BMI and quality of sleep with r = 0.025 and N = 350. Reported sleep quality of very bad to fairly bad was statistically higher among night shift nurses with a valid percentage of 44.8% compared to day shift nurses with a valid percentage of 28.4%. Thorough analysis of PQSI scores, though not completed, may provide additional information on the relationship of shift worked, sleep quality, and elevated BMI. Education on sleep promotion and methods to improve sleep quality should be provided to night shift nurses. Currently, night shift napping is being implemented as a primary intervention in improving quality of sleep among night shift workers.
Client outcomes: 1. The increased frequency of lower sleep quality among night shift nurses should be considered an external environmental stressor on the nurse with the potential to invade his or her lines of defense. 2. In applying the physiological and psychological variables described in the NSM, the stressor of very bad to fairly bad sleep quality has not impacted the nurse client system as demonstrated by an elevated BMI.
Teaching the Neuman Systems Model in the Context of Nursing Research at the Baccalaureate Level
Nancy Johnston PhD CRNP, Assistant Professor of Nursing & Elizabeth Detweiler, RN, BSN Kimberly Giarrizi BSN Staff Nurse Nicole Snyder BSN Staff nurse Tarashea Seburn BSN Staff Nurse Cedar Crest College Allentown Pennsylvania USA
Purpose: The purpose of this paper is to share an innovative classroom assignment in a senior nursing research course.
Conceptual Framework: In 2009, As a result of adopting the NSM as a foundation for the Nursing curriculum, faculty were encouraged to incorporate different ways in which to Neumanize their courses. Evidence based practice concepts of developing a literature synthesis embedded in Nursing 332: Nursing Research II provided an opportunity for senior students to use clinical nursing research case studies and reports to devise an evidence table using Neuman.
Methodology: Nursing research studies based on the Neuman Systems Model were retrieved from a literature search using key words “Neuman Systems Model”, “clinical nursing research”, “evidence-based practice” found in 3 data bases. Four seniors volunteered to test this approach with faculty guidance. Twenty five studies were found. Each student took one study to critique for the poster and class presentation.
Results: A twenty minute class presentation, 2’ by 3’ original poster with evidence table, and a scholarly paper were created by this team of senior nursing students. These would be presented at the NSM Symposium if chosen.
Discussion: The students commented that “this is a great way to get to know a famous nurse thinker”. Faculty evaluation revealed that the students were well-equipped based on previous nursing courses such as concepts, leadership, and a 2 credit research introduction to search the literature, critique studies founded in Neuman and develop a small evidence table.
Implications: This first trial of assigning students to critique nursing studies based on a model like Neuman’s proved successful and could be tested in other nursing programs and with other nurse researchers.
The participants will have the following knowledge at the end of this presentation: 1. Describe student outcomes in a nursing research course allowing for the study of the Neuman Model. 2. Observe a sample presentation from undergraduate senior nursing majors critiquing the NSM as it appears in the general nursing research literature. Reducing the Risk of Serious Falls among the Nation’s Elderly: A Model Assessment and Intervention Program
Lisa Lacko, MSN, RN, Assistant Professor of Nursing Karen Bensinger, MSN, CNRP, Nursing Instructor Lisa Shustack, MSN, RN, Nursing Instructor Nancy DalPezzo, PhD(c), RN, Assistant Professor of Nursing Mae Ann Pasquale, PhD, RN, Assistant Professor of Nursing Karen Boutron, MSN(c), RN, Graduate Student Dr. Michael Sarver, Assistant Professor of Mathematics Cedar Crest College Allentown, Pennsylvania USA
Study Purpose: The goal of this project is to reduce the risk of serious falls through a model prevention program in an elderly population. This study investigated the effects of an individualized fall-risk assessment and participation in an exercise program on balance and fear of falling (FOF) in a group of healthy community-dwelling elders, who live in independent, senior housing. Conceptual Framework: The Neuman Systems Model (NSM) served as the framework. The construct of health was manipulated by implementing exercise programs designed to improve balance through intervention, depending on the client’s health status. The goal was to strengthen balance and increase the client’s flexible line of defense, therefore decreasing fall risk. For those already at risk, the intervention served to increase the lines of resistance and allow for reconstitution. Methodology: Using a quasi-experimental design, fifty-four elders, aged 65 or older, participated in three different, one-hour exercise sessions (yoga, Tai Chi, physical therapy) over seven weeks. Implemented as a geriatric experience, junior nursing students conducted face to face client and environmental risk assessments, and collected balance and FOF measures, using the Tinetti Balance and Gait Evaluation and the Tinetti Falls Efficacy Scale respectively, at baseline and at the end of intervention. Data were analyzed using descriptive and inferential statistics. Results: Preliminary analysis revealed improvements in balance and FOF following the implementation of the exercise programs. There appears to be no significant differences between the different types of programs implemented. Discussion: The results suggest that a short-term exercise program can improve balance and reduce FOF in community-dwelling elders. Whether these results are clinically significant needs further analysis. Implications: The findings support exercise as an intervention in the elderly. Further investigation is needed to determine if this is a sustainable model program for reducing falls in the elderly. The NSM was an effective framework for informing the project design.
Objectives: 1. To discuss the concept of a model fall-prevention program in an elderly population. 2. To describe the application of the Neuman Systems Model incorporated into a model fall-prevention program. Time Worn or Timeless: A Case for the Neuman Systems Model Lois W. Lowry, DNS, RN, ANEF Professor Emerita, Retired East Tennessee State University Nebo, NC USA
This position paper presents arguments in support of the longevity of the Neuman System Model as an appropriate framework to guide practice, education and research.
Based upon cultural influences both at the time of origin of the model and 30 years later, the author establishes her case. The cultures of nursing and medicine in the early 1970’s are described, as well as other cultural factors within health care and nursing education, including the scientific thinking of the day. The paper shows how Dr. Neuman heeded these influences as she developed her model.
Then the author fast forwards to the present day and reflects on the cultural factors that have an impact on nursing, medicine, healthcare and life in general in the 21st century. Does the Neuman Systems Model have a place in this rapidly changing world, or has it become an historical artifact? Are the model concepts and propositions relative to the thinking of today? How are the nursing goals and actions of today updated from those of 30 years ago? How does nursing educationbuild upon its theoretical roots? As these questions are answered, participants can make an informed and confident choice about the use of the NSM in their own practice, education and research.
Outcomes: 1. Cultural influences of the 1970’s are described in relation to their influence on the development of the NSM. 2. Congruence of the NSM propositions with today’s culture is validated.
From Instructional Epitome to Scholarly Learning Community: High Hopes for Online, Self-study Learning of the Neuman Systems Model.
Maureen Mackey, RPN, RN, BSN, MDE (Candidate), Faculty Member Anna Helwewka, Program Coordinator & Faculty Member Department of Psychiatric Nursing, Douglas College Coquitlam (Metro Vancouver), British Columbia Canada
This presentation provides an overview of an online, self-study learning module developed for psychiatric nursing students and new faculty members to learn about the Neuman Systems Model of Nursing (NSM), which is fundamental to the Department of Psychiatric Nursing curriculum framework. Developed from evidence-based instructional systems design theory, this presentation will demonstrate the online learning module which employs the structure of the NSM as an organizer, presenting the most superordinate, all-inclusive concepts first, such as systems thinking, while providing participants early opportunities to apply the concepts via basic yet active, asynchronous online learning. The first unit of instruction provides an epitome, teaching the overarching generalizations of the Model at the application level, and will be presented. An intriguing aspect of the epitome is the idea that the entire Model can be discovered at the most concrete level of application possible. Subsequent instructional units develop the details of the Model, culminating with the established case study method of instruction while transparently articulating the primary prevention intention of the learning activities. The online NSM learning module has potential for more sophisticated use—as a hub for scholarly activity relevant to the Model. Possibilities are boundless; once established, members of the learning community may co-construct ongoing course development relevant to the NSM, thus leading to an ever-evolving and flexible system.
Participant Outcomes: 1. Participants will appraise the utility of the online, self-study learning module in providing introductory and ongoing knowledge of the Neuman Syste 2. ms Model to psychiatric nursing students and faculty members. 3. Participants will challenge the presenter to improve the instructional unit presented. Medieval Metaphorical Adaptation of NSM as an Educational Tool in the Patient Simulation Laboratory
Marilyn L. McClure BSN, RN Adjunct Instructor, Patient Simulation Laboratory Mesa State College Grand Junction, Colorado USA
Background: High-fidelity patient simulation laboratories are increasingly being used within nursing education. Realistic patient care scenarios can be created within this safe learning environment. In this setting, students strive to synthesize theory, research, physical nursing skills, and critical thinking into sound, evidence-based patient care decisions. Mauro (2009) encouraged simulation educators to “start small and build from simple to the complex” (p. 31), so students are not discouraged from this new experience. The debriefing period immediately following patient simulation is the most critical time for students to connect all events of the scenario. A framework with which to accomplish this was identified as a need.
Purpose: Smith (as cited in Rose, 2010) noted that metaphor can stimulate “an intuitive grasp…and foster a holistic insight in a moment” (p. 215). This paper presents a medieval metaphorical adaptation of the Neuman Systems Model (NSM) for use as an educational tool within the simulation laboratory. In debriefing, the visually colorful framework allows nursing students to follow NSM through the use of familiar characters to reach decisions about a patient’s status and care decisions. The companion debriefing questionnaire provides a measurement tool for performance evaluations.
Discussion: Environmental stressors, the flexible line of defense, the normal line of defense, inner lines of resistance, and the central core are graphically represented as interacting medieval characters whose purpose is to protect the vital central core at all costs. Primary, secondary, and tertiary preventions can be viewed as defensive weapons in this effort.
Conclusion: Preliminary discussions with educators and senior nursing students indicate that this novel approach may help students to bridge the gap between nursing theory and application to their practice which is learning the art and science of nursing.
Objectives: 1. To provide an educational debriefing tool to increase student understanding and analysis of simulation scenario events. 2. To provide a written measurement tool to assess student learning and assist with student performance evaluation.
Mauro, A. M. (2009). Jumping on the simulation bandwagon: Getting started. Teaching and Learning in Nursing 4(2), 30-33. doi: 10.1016/j.teln.2008.09.002 Rose, B. H. (1999). A basket metaphor for nursing. Journal of Holistic Nursing, 17(2), 208-217. Retrieved January 24, 2010, from http://jhn.sagepub.com.ezp.waldenulibrary.org/cgi/reprint/17/2/208 Actualizing the Neuman Systems Model as the Framework for a New Baccalaureate Nursing Program
Betsy M. McDowell, PhD, RN, CNE Professor and Chair, Department of Nursing Newberry College Newberry, South Carolina USA
In 2007, a new baccalaureate nursing program was initiated at Newberry College, a small, liberal arts, Christian college in South Carolina offering undergraduate degrees in 26 majors. The Neuman Systems Model (NSM) was chosen as the conceptual framework for the new baccalaureate nursing program. The model’s emphasis on holistic assessment including the spiritual variable, its applicability with diverse client systems and in a variety of clinical settings, and the importance of nurse/client collaboration were key factors in this decision.
The “Guidelines for Neuman Systems Model-Based Education” (Newman et al., 2011) were followed in developing the program, including the focus of the curriculum, the nature and sequence of content, identification of settings for education, characteristics of learners, and selection of teaching-learning strategies. This presentation includes an overview of the journey to a Neuman-based nursing program from the administrator, educator, and student perspectives. Examples of the integration of the Neuman Systems Model through all aspects of the program and curriculum will be provided. Specific strategies for providing NSM-based nursing education in the classroom as well as in the clinical areas also will be presented.
Upon the completion of this presentation, participants will be able to: 1. Examine the components of Neuman Systems Model-based education and how these were actualized in a baccalaureate nursing program. 2. Identify at least 8 strategies for providing NSM-based nursing education in the classroom and in the clinical setting. A Guide for Practice at the Bedside and in the Boardroom
Deborah Napier, BSN, RN, MA, LICDC Clinical Outcomes Manager Orthopedic Services & Angela Surace MS, CNS-BC, SNP-BC, RN-BC Clinical Nurse Specialist Riverside Methodist Hospital Columbus, Ohio USA
In 2003, nursing leadership including educators, directors, a researcher and staff nurses reviewed several theoretical models during a preliminary gap analysis in preparation for pursuing Magnet Recognition. The Neuman Systems Model was chosen as it was applicable for any area or setting of nursing practice and most like the care we provided. Consistent with our mission, vision and values, the theory considers the continuum of care and aligns with our Philosophy for the Discipline of Nursing.
The elements of the Neuman Systems Model for patient care transfers readily to our health care system. Over the next several years, organizational examples of this holistic approach became apparent. Areas of need included a formal shared governance structure and opportunities for sharing best practice.
By assessing our continuum of wellness as related to interacting variables, lines of defense and stressors, we were able to promote systematic thinking and reduce operational silos. For example, a significant revenue loss from the departure of several physicians prompted a demand hospital-wide for increased productivity to meet budget goals. The shared governance structure, a primary intervention, provided a degree of wellness and lines of defense to sustain the stressor of this demand.
Informing and empowering the staff through public forums forged a strong support to promote productivity. This openness and transparency fostered additional creative solutions for reducing expenses. By the end of the fiscal year, financial health was reestablished by direct influence of nursing.
Knowing that all systems are dynamic and in a constant state of change, we are confident that the Neuman Systems Theory provided the best model to guide our success.
Objective: 1. Describe a hospital’s process for determining a nursing theoretical framework 2. Describe a hospital’s application of the Neuman Systems Model at the clinical and administrative level.
Spiritual Needs of Care Dependent Elderly in a Nursing Home in The Netherlands
Dora T. Schiphof-Halma MScN, RN Health Scientist & Associate Professor Reformed University of Applied Sciences, Knowledge Network of Health Care and Spirituality Zwolle The Netherlands
Study purpose. A pilot study was conducted to assess spiritual needs and spiritual involvement of care dependent elderly in a nursing home in The Netherlands.
Conceptual framework. The curriculum of the Faculty of Health Care is based on the concept of NSM. There is explicit attention for the spiritual variable in education and in research. In this research we focused on the spiritual variable of care dependent elderly. Little information is available on the spiritual needs of care dependent elderly in nursing homes in The Netherlands. It is unknown what elderly define as their spiritual needs and what their expectations are regarding to the role of nurses and other caregivers in delivering spiritual care.
Methodology. The study sample consisted of 23 care dependent elderly of 65 years and older living in a nursing home. Data were collected by a structured questionnaire on spiritual needs based on the spiritual needs model of Fitchett (1993) and the Spiritual Attitude and Involvement Scale (SAIL).
Results. Most important spiritual needs of care dependent elderly: to feel connected with residents, family or church members (96%); listening to music (91%); having a chat with residents or nurses (87%); to be in nature (83%); life review (83%) and peace and quietness (78%). The SAIL showed high involvement in nature (70%), care for others (59%) and acceptance of burden of life (57%).
Implications. A lot of spiritual needs are important to many care dependent elderly. Three items of the SAIL had a high score but still lower than the spiritual needs. The questionnaire on spiritual needs seems to be a practical tool to explore the spiritual variable of care dependent elderly in nursing homes.
Participant outcome: It is important to talk to care dependent elderly to clarify their spiritual needs. Nurses and other caregivers should ask care dependent elderly about their spiritual needs because they are perfectly able to indicate what their spiritual needs are.
Fitchett, G. (1993). Assessing Spiritual Needs; a guide for caregivers. Fortress Press, Augsburg.
Spiritual Attitude and Involvement Scale (SAIL), www.hdi.nl Perceived Confidence of Baccalaureate Nursing Students in Providing Spiritual Care
Robbie M. South, MSN, APRN, PHCNS-BC D.H.Ed.(c) Associate Professor Lander University Greenwood, South Carolina USA
Purpose: The purpose of this research will be to enhance the instruction of baccalaureate nursing students in assessment and interventions related to the spiritual dimension and to provide a forum for exploration of students’ own spirituality in order to determine if the intervention increases their confidence in providing spiritual care for clients. Examining the efficacy of enhanced education to increase confidence will provide evidence for instructional methods for educating nurses in the area of spirituality.
Conceptual Framework: The Neuman Systems Model will be used as a guide for client assessments. The importance of including all client variables in a holistic assessment will be stressed with special attention to the spiritual variable. Students will explore their own spirituality, the belief systems of major religions, spiritual assessment tools, and spiritual care interventions.
Methodology: A quasi-experimental design with non-randomized control group using pretest-posttest design will be used for this study. Open-ended questions will also be included to evaluate the nursing students’ perceptions of spirituality and spiritual caregiving. The study participants will complete four instruments through an online survey service.
Results: The educational intervention will be a 3-semester hour elective course entitled Spirituality in Nursing. The course will be offered online at a liberal arts university in SC during the fall 2010 semester to junior and senior prelicensure and RN-BSN students. Data will be collected at the beginning and end of the semester.
Discussion and Implications: This study will contribute to the knowledge of the discipline on the topic of spirituality. The research will provide insight into the value of curriculum revisions relative to spiritual care topics and will assist nursing educators in planning spiritual care educational offerings. The research will also provide additional topics for future research.
Objectives: 1. Participants will be able to discuss why practicing nurses often omit spiritual care. 2. Participants will be able to discuss how enhanced education in spirituality in nursing affected the perceived confidence of baccalaureate nursing students in providing spiritual care. Orienting Nursing Students to the Neuman Systems Model: Development of an Interactive Learning Module
Joan T. Timalonis, MSN, RN, CNE, Assistant Professor Heather Lynn Clark, MSN, RN, Nursing Instructor Matthew Kile, Instructional Designer Cedar Crest College Allentown, Pennsylvania USA
In 2009, Cedar Crest College Nursing Faculty adopted the Neuman Systems Model as the organizing framework for the Undergraduate Nursing Curriculum. The need to launch the Neuman Systems Model (NSM) in the nursing curriculum resulted in the development of an Interactive Learning Module based on the NSM. Nursing faculty collaborated with the Information Technology specialist to produce a self –paced, interactive web-based tool to introduce the NSM to nursing students on a meaningful and personal level. The learning module can be used by the student multiple times to reinforce basic concepts of the theoretical framework. A glossary of terminology and additional resources for understanding the NSM are also provided in the module. New and adjunct nursing faculty can also learn the NSM using this approach. The purpose of this presentation is to 1) describe the process for development of the interactive learning module, 2) present the educational web-based tool to the learners, and 3) discuss an affective learning strategy used in the module by demonstrating the application of the NSM to the nursing student beginning her/ his education at Cedar Crest College.
Participant Objective:
Following the presentation of the Neuman Systems Module, participants will be able to: 1. Describe the process for development of the interactive learning module 2. Present the educational web-based tool to the learners 3. Discuss an affective learning strategy used in the learning module
The H1N1 Pandemic Response: Role of Primary and Secondary Preventions
Kathleen O. Vito, PhD, PHCNS-BC, RN Associate Professor of Nursing, Richard Stockton State College Pomona, New Jersey & Clinical Nurse Specialist in Public Health Emergency Preparedness Cumberland and Salem Health Departments (New Jersey) USA
The Neuman Systems Model was used to structure an analysis of the American Public Health Care System’s response to the H1N1 pandemic. After action reports from the federal level and selected states were used as sources of data in which to create a “report card” of planning, implementation and outcomes of primary, secondary and tertiary levels of prevention. While the media and other critics of the public health response have questioned whether the population was at risk of a global pandemic with high mortality, analysis of the response at the intrapersonal, interpersonal and extra personal systems level reflect an effective response of primary prevention measures such as hand hygiene, social distance, respiratory hygiene and encouragement to self isolate people with symptoms at home. These and other preventions to strengthen the flexible line of defense were the only public health measures available until a vaccine could be developed and tested. While immunization with a newly developed vaccine was viewed as an effective prevention, the vaccine was not available until midstream into the second wave of the pandemic. The population response to the availability of free vaccine was poor. Only 36.8% of the initial Center for Disease Control and Prevention (CDC) target population sought immunization. In December 2009, the CDC lifted restrictions as to priority groups due to greater availability but the rates of immunization did not increase appreciatively. A third wave of the pandemic did not materialize due to effective primary and secondary preventions. The Neuman Systems model is a comprehensive framework that can be utilized guide population based care programs and outcomes. In this analysis of the public health response to the threat of H1N1, primary preventions were instrumental reducing the spread of illness in the United States.
Participant Outcomes: 1. Apply the Neuman Systems Model to an analysis of the public health response to H1N1
2. Identify the importance of primary preventions for population based care in the face of an emerging pandemic
Abstracts for Poster Presentations Using the Neuman Systems Model to Guide the Care of Adolescent Victims of Dating Violence
Barbara Scott Cammuso PhD, EdD, ANP, GNP-BC Professor Emeritus, Fitchburg State College Shrewsbury, MA USA
The purpose of this presentation is to explore the physiological, psychological, developmental, sociocultural, and spiritual stressors of adolescent females who are the victims of dating violence. The positive and negative created environments will be examined in order to provide a understanding of the perceptions of the victims. Problem solving strategies will be discussed that will assist caregivers to help victims set and meet realistic goals, strengthen the lines of defense, and promote optimal wellness.
Dating violence is abuse carried-out by a teenage individual in order to control or dominate another teenage individual during a relationship. The types of dating violence include physical, emotional, sexual, and economic. Teen dating violence has increased in recent years and adversely affects the people from all socioeconomic and cultural groups. The Neuman Systems Model will provide a framework to guide interdisciplinary caregivers to comprehensively identify risk factors for adolescent dating violence and the associated system invasion. This theoretical framework will also offer structure to assist caregivers to assess, and plan prevention interventions for clients, families and communities.
Objectives: 1. Identify the adolescence dating victim's risk factors leading to violence. 2. Examine the positive and negative creative environments of victims of adolescent dating violence. 3. Discuss the use of the Neuman System Model to assess victims of dating violence. 4. Explore prevention interventions used to treat victims, families, and communities.
Developing Positive Strategies for Minimizing Weight Gain in the Inpatient Mental Health Setting
Lisa Davidson BSN, RN, BC South Jersey Healthcare Bridgeton, New Jersey USA
Background: The negative impact of being overweight (obese) and related treatment on children’s and adolescent’s health/wellbeing has been shown in a few specific samples.
Methods: Participants are inpatient children/adolescents on IBCU. On admission, a metabolic profile is obtained with reassessment bi monthly and at discharge. Groups and individual treatment on nutrition, exercise and education are attended and participated in throughout their stay. A treatment goal of health/wellness is included in the individual treatment plans with more specific goals agreed upon weekly by client and treatment team. Included in discharge plan, are strategies to maintain weight out patient.
Theory: The Neuman’s System Theory guides this process with the structure of wholism. A review of the five variables reveals the expansive implications of this effort: · Physiological: Balancing intake with activity levels is a life-long primary intervention · Psychological: Re-establish emotional balance is a common care plan area in behavior health. An adolescent since of self control can expand to other life areas · Sociocultural: Social support of healthy concepts and accomplishments are common. These shared values help establish meaningful relationships with peers and care providers · Spiritual: Measurable improving health helps our adolescents develop meaning and direction. Developing a sense of hope and improving future is key to behavioral change and motivation · Developmental: Integrating healthy living concepts into ones behavior patterns is a positive developmental.
Reconstitution to behavior consistent with healthy living is the initial goal that will reduce the patient’s risk of physiological stressor (weight related illness). The larger accomplishment is helping adolescents recognize their ability to control their bodies, behavior and future.
Results: Since implementation, participants overall have maintained weight. Outcomes: decrease in mental health symptomology as well as recidivism.
Conclusion: By addressing obesity (overweight) issue in this population, both physical and emotional wellbeing are improved.
Bariatric Surgery Lifestyle Alterations: Are Patients Coping?
Roseanne M. DeFrancisco, MSN, RN Clinical Outcomes Manager South Jersey Healthcare Elmer, New Jersey USA
Purpose: Obesity has become a worldwide health issue associated with increased mortality and increased risk for coronary artery disease, hyperlipidemia, diabetes, and cancer. With the rise in obesity over the past thirty years, weight loss surgeries have gained popularity among the general public. Along with the physical effects of obesity, many individuals suffer from a variety of psychosocial issues such as depression, poor self esteem, compulsive eating and lower socioeconomic status. The goal of the research is to study a population of postoperative bariatric patients ranging from three months to eighteen months after surgery.
Method: This mixed method triangulated study assesses postoperative physical activity, quality of life and the lived experiences of postoperative bariatric surgical patients. The Neuman Systems Model serves as the theoretical framework for this study. Valid and reliable quality of life tools utilized included the Duke Activity Status Index and the PHQ-9. The small scale phenomenological study also incorporates a one on one interview that also considers coping mechanisms and how patients confront issues such as dietary and hydration issues, body image disturbances, vitamin supplementation and lifestyle changes.
Findings: Significant statements spoken by the participants were observed and evaluated to specifically express these recurrent themes: lifestyle alterations, self esteem, relationships with others, and the effects of support. Preliminary results also yield that postoperative bariatric patients are making modifications to daily life in order to meet the challenges faced after surgery. A lifetime commitment to behavior modification and lifestyle changes are realities to the bariatric patient and participants appear to be adjusting to the changes in lifestyle with the support of family and friends. While the study remains ongoing, the objective is to verify the coping mechanisms of post bariatric surgical patients in the months and years after surgery.
Objectives: Upon completion of the poster review the attendees will: 1. Describe the four themes that emerged from the qualitative nursing research study “Bariatric Surgery Lifestyle Alterations: Are Patients Coping?” 2. List the coping mechanisms of postoperative bariatric surgical patients in the months and years after surgery.
Electronic Health Records for Nursing Education: Integrating Technology into the Nursing Curriculum
Pamela S. DeKoninck, MS, RN, Continuing Lecturer Katrina Kessler, BS, RN, Graduate Student Rachel Ramsey, BS, RN, Graduate Student Tammy Toscos, MS, PhDc, Visiting Lecturer Indiana-Purdue University Fort Wayne/Parkview Department of Nursing Fort Wayne, Indiana USA
Purpose/Objectives: Analyze the use of Electronic Health Records (EHR) to stimulate the critical thinking and decision making required of students in real clinical settings by: 1) integrating current written work into the EHR and 2) creating a robust database of simulated patient cases, including diagnostic test results, physician orders, medications and physical assessment data. Currently, in order to enhance the students’ level of critical thinking, a weekly worksheet is completed utilizing a template in a Word document. The client’s physical, psychosocial and spiritual needs or “stressors” are identified and analyzed using the Neuman Systems Model (NSM).
Background: EHRs are a general category of software used by healthcare organizations to document all aspects of patient care. The dynamic healthcare environment challenges nursing faculty to produce graduates who are not only comfortable using technology, but more importantly, possess the ability to interpret, analyze and synthesize clinical data that are stored in EHRs.
Design/Sample: The qausi-experimental study with a pre-test, post-test design employed a sample consisting of two semesters of students who were enrolled in Medical-Surgical Nursing of Adults, II, a didactic and clinical course with an average enrollment of 60 students.
Methods: Data collection included a comparison of assessment paper grades from the first semester to the second, and a questionnaire completed by students prior to (Spring, 2010) and after (fall, 2010) the project implementation.
Findings: The study is in progress with completion of work and data collection planned for December, 2010 with data analysis to follow.
Implications for Nursing: The EHR can be used to document nursing students’ patient care activities after weekly clinical experiences. The EHR documentation will use the NSM variables and the nursing process in assessing, planning, creating outcomes, implementing, and evaluating the overall plan of care for the client.
Participant Outcomes: 1. Describe the use of Electronic Health Records to stimulate the critical thinking and decision making required of students in real clinical settings. 2. Discuss the implications for use of Electronic Health Records in an undergraduate nursing program. Early Detection Could Save Lives - Colon Cancer Awareness
Kathy L Hall RN, CGRN Bonnie Smalley RN, CGRN South Jersey Healthcare-Regional Medical Center Society of Gastroenterology Nurse and Associates Vineland, New Jersey USA
Each year millions of people die of colon cancer. The Endoscopy Department held its second open house to educate the public about this dreadful disease. With a large Spanish speaking community, all postings about the event and information was provided in Spanish and English. To help lessen intrapersonal stressors, many stations were set up for the attendees to visit. As primary prevention, literature about colon cancer, dietary information about colon preps and foods acceptable to consume during the preparation, and a simulated colonoscopy was demonstrated. Anesthesia staff was available to answer any questions or concerns pertaining to the use of anesthesia during the procedure. The physiological, psychological, sociocultural, spiritual, and developmental person variables were all addressed in this event. A PowerPoint presentation, given by one of our physicians, shared some staggering statistics about colon cancer. When asked why many of them had not had a screening colonoscopy done some stated “lack of information, fear of the unknown, cost and that their primary physicians had never suggested it.” The PowerPoint demonstration ended with a personal testimony of a colon cancer survivor. Attendees who were concerned about the financial aspect were referred to a representative from the New Jersey Colon Education and Early Detection program, where they found literature on how to get a free colon screening. It was hoped that this event would strengthen participants’ flexible lines of defense through knowledge of and action to colon cancer screening. Participant surveys showed the event was a huge success. To date, ten new patients were seen at physicians’ offices for screening colonoscopy. The number of attendees tripled from 50 the first year to 150 this year. The most important statement that day was that colon cancer is preventable, treatable and beatable with early diagnosis.
Objectives: Upon completion of the program, participants will be able to 1. Describe the signs and symptoms of colon cancer 2. List common stressors that hinder patients from seeking early colon cancer screenings
A Holistic Approach to Geriatric Patient Care: The Development and Implementation of NICHE (Nurses Improving Care for Health System Elders) Rounds
Jean MacIntyre, RN, Assistant Nurse Manager, 1 East Lisa Cossaboon, RN, CMSRN, Assistant Nurse Manager, 1 East South Jersey Healthcare Vineland, New Jersey USA
Approximately 50% of hospitalized patients are over the age of 65, creating a need for geriatric focused care. This unit is a 24 bed unit with a daily average of 10 patients 65 and older. NICHE rounds were implemented twice a week to further identify the needs of the geriatric population. In patients 65 and older, the flexible lines of defense may have lessened over time, providing inadequate protection to the normal lines of defense, which may also be lacking in vitality. This may make geriatric patients vulnerable, at risk for assaults to their central core structure from intra-personal, inter-personal, and extra-personal stressors.
The Neuman Systems Model is utilized by the interdisciplinary team, composed of: Pharmacy, Physical Therapy, Occupational Therapy, Dietary, Social Worker, Case Managers, Care Coordinators, Respiratory Therapy, Physicians and Nursing to assist in strengthening these lines of defense in geriatric patients. In NICHE rounds, the interdisciplinary team follows the patient holistically and identifies any needs the patient may have during hospitalization and at discharge. This team facilitates shared knowledge and expertise on primary, secondary and tertiary care. As issues arise NICHE rounds attempts to lessen patient stressors by working together to build a plan of care that supports patient needs while communicating and implementing corrective actions and improving healthcare for elders.
The NICHE rounds also focus on the management of the disease process and implements services that help maintain independent living as long as possible. The rounds concentrate on: sleep pattern, nutritional intake, patient orientation, fall risk, skin integrity, incontinence, medication issues, pain, family support and discharge needs. In treating the patient holistically; physiological, psychological, socio-cultural, developmental, and spiritual variables are considered. The Neuman Systems Model has facilitated the incorporation of all aspects of the patient to restore or maintain system homeostasis.
A survey of the NICHE Rounding Team found: 100% perceive improved interdisciplinary communication and a positive impact from NICHE rounds to improve patient care. On average 75% of patients had medication interactions, needed PT/OT evaluations, or help with transition from hospital to community. NICHE rounding may decrease readmission rate thereby decreasing healthcare costs. The interdisciplinary team working together could result in improved teamwork creating better patient outcomes. Having better patient outcomes could improve patient and staff satisfaction.
From this presentation, the participants will be able to: 1. Discuss the Neuman Systems Model as a framework for NICHE rounds. 2. Evaluate the merit and feasibility of implementing NICHE rounds in one’s home institution. Correlation of Clinical Data Manager Program in Relation to Work Ethic and Course Outcomes
Donna Mitchell Ph.D., RN, Director University of Rio Grande Holzer School of Nursing & John Mitchell BSN, RN, BCS, Clinical Analyst Fairfield Medical Center Wellston, Ohio USA
The purpose of this study is to correlate nursing student clinical experiences with passing the NCLEX. A clinical data manager has been created and will be implemented Fall Semester 2010 at a university in southern Ohio to determine clinical factors such as patient groupings, skill application, student and instructor accountability, and clinical learning opportunities. The conceptual framework for this project is Neuman Systems Model. Dr. Neuman personally recommended her model as the appropriate framework to guide this study and encouraged submission of this abstract.
The methodology is a quantitative approach that correlates clinical factors such as patient groupings, skill application, student and instructor accountability, and clinical learning opportunities with NCLEX success. The data will be collected through the use of a clinical data manager that has been developed by these authors to monitor nursing students in the clinical setting over a period of one academic year.
The data will begin to become available in May 2011 and data analysis will begin at this time. It is anticipated that preliminary results will be analyzed and data collection will continue. The anticipated results are that there is a correlation with clinical factors such as patient groupings, skill application, student and instructor accountability, and clinical learning opportunities with passing the NCLEX on the first attempt.
A discussion of the outcomes relates to measures that may be implemented to increase NCLEX success for nursing students. Clinical experiences are required of all students and it will be an advantage to determine which experiences are most critical to NCLEX success. The implications of this study are for better patient assignments on clinical units with the goal of higher pass rates on the NCLEX.
Participant Outcomes At the completion of this presentation participants will be able to; 1. Describe potential clinical factors related to course success 2. Identify the correlation between work ethic and clinical experiences
Application of the Neuman’s Systems Model (NSM) to the SJH Behavioral Health Department’s Wellness and Recovery Program (WRAP)
David Moore MSN, RN, BC Carol Burkhardt-Fuentes, RN Bonnie Price, BA MSHA South Jersey Healthcare- Behavioral Health Bridgeton, New Jersey USA
Wellness is a personal perception of accomplishment. Facilitating personal insight and independence are the goals that guide WRAP plan development. Each patient within the behavior health department is encouraged to develop a WRAP plan. This WRAP plan follows the patient throughout the behavior health care continuum. The patient owns and continually develops their plan, which requires ongoing motivation and effort. The NSM reinforces the importance of spirituality to perceived wellness, as this is the basic origin of behavior and motivation. Neuman states that the relationship between the spiritual variable and wellness may be better understood and utilized “as an energy source to achieve client change and optimal system stability” (p.30). Understanding wellness as a perception, not an assessment, is the key concept for the patient and care provider to grasp when developing a WRAP plan.
The NSM reinforces that recovery requires the process of reconstitution. The ability of the Lines of Defense and Resistance, and the variables which make up those lines to be flexible, helps maximize the ability to reconstitute and recreate a new normal line of defense. Neuman defines the reconstitution process 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). WRAP plans are authored by the patient and include self developed goals or commitments. The plan develops a pathway towards reemergence of a positive self-image that is critical to reconstitution, wellness and recovery. The concepts and structure of the NSM is applied within every WRAP plan developed within the SJH behavioral health department. The NSM is a pathway to wellness and recovery and the WRAP plans are an application of the model.
Objectives: 1. To show the concepts and structure of the NSM and how it is applied within every WRAP plan developed within the SJH behavioral health department. 2. To show how the NSM is a pathway to wellness and recovery and the WRAP plans are an application of the model.
The Relationship of Stress Resiliency, Empowerment and Conflict Management Styles among Baccalaureate Nursing Students
Eula W. Pines, PhD, APRN, PMHCNS, BC, Associate Professor of Nursing Maureen Rauschhuber, PhD, RN, BC, Associate Professor of Nursing Jennifer Cook, PhD, RN, Assistant Professor of Nursing Gary Norgan, PhD, RN, Professor of Nursing Leticia Canchola, MSN, RN, Instructor of Nursing Cynthia Richardson, MSN, RN, Instructor of Nursing Mary Elaine Jones, PhD, RN, PNP, Professor of Nursing and Endowed Chair University of the Incarnate Word San Antonio, Texas USA
Horizontal violence in the workplace results in feeling powerless, lowers stress resiliency, and threatens retention of new nurses and student nurses. This study used a descriptive correlational design to describe student experiences of conflict in the workplace, explore the interpretative habits of students influencing stress resiliency and perceptions of empowerment, and examine relationships of stress resiliency and psychological empowerment to conflict management styles of 166 baccalaureate nursing student volunteers enrolled in a private Hispanic-serving university.
Neuman’s Systems Model constructs of central core of energy resources, lines of resistance and flexible lines of defense in managing stressors are linked to the variables of the study. Primary prevention in conflict management occurs before the system reacts to a stressor and strengthens the individual’s line of defense, increasing the resiliency of nursing students and empowering them to cope with the stressor of interpersonal conflict.
Data collected from four instruments, Stress Resiliency Profile (Thomas & Tymon), Psychological Empowerment Instrument (Spreitzer), Conflict Mode Instrument (Thomas & Kilman), and a demographic questionnaire, were analyzed using descriptive and inferential statistics.
Most participants were female, single, Hispanic and 25 years old. One-third reported experiencing conflict in the workplace. Students scored in the high range for focusing on their deficiencies or negatives instead of positives in a situation; they scored above the 60th percentile for avoiding and accommodating behaviors to manage difficult situations and were less likely to use competing or collaborating strategies to manage conflict. All scores on empowerment were significantly correlated with stress resiliency scores. Students with high scores on empowerment had high scores on skill recognition suggesting more resilience; high scores on empowerment were related to high necessitating scores suggesting a predisposition to stress.
Nurse educators
can design interventions to strengthen student resilience and empowerment to
engage in conflict using appropriate conflict management strategies. Participant outcomes: 1. Participants will be apply Betty Neuman’s conceptual framework to describe the stress resiliency, empowerment, and conflict management styles among 166 baccalaureate nursing students. 2. Participants will be able to describe factors associated with responses of student nurses and new nurses to interpersonal conflict in the workplace. Using Neuman System Model to Improve the Quality of Nursing Practice in Public Health Unit: a Pilot Project at Sint Carolus Health Services, Jakarta, Indonesia
Ros Isti Rahayuningsih, CB, BSN, Director of Nursing Bernadethe Marheni Luan, MA, (Nursing)/Lecturer Bekti Wahyuni, BSN, Chief of Nursing Committee Yuliana Aten, BSN, Facilitator Linda Sitanggang, BSN, Facilitator Anna Estining R.W., Facilitator Dyah Caturisyanti, BSN Oliva Nizacora, BSN Anastasia Purwaningsih, BSN Erna Agnes Sitompul, Diploma in Nursing Sint Carolus Health Services Jakarta Indonesia
In 1994 a group of Community Health Nurses (CHNs) had been introduced Neuman System Model (NSM) after Nursing Committee rigorously chose it as an appropriate model to guide nursing practice in public health setting. In 2006, a task force which composed of senior nurses was established to apply the NSM with the aim to improve the quality of nursing care in public health units (PHUs). The implementation was done in 2008.
NSM is a comprehensive model that provides directions for assessment and intervention to level of clients, ranging from individual, family, and group to the community from the perspective of primary, secondary and tertiary preventions. Nurses at the outpatient service of PHU look at individual as an entry point to reach out family, the smallest of unit care.
Tools for assessment and nursing care documentation were developed based upon key components of the model. The CHNs were trained the NSM and how to utilize tools. A PHU was chosen for pilot testing followed with evaluation and improvement of the tools and strategies of implementation. The questionnaires were sent out to patients, CHNs, general practices (GPs) before and after a three-month of implementation to determine the effectiveness of model and patient satisfaction. The evaluation shows increase by 9.11% of CHNs’ competency in communication and discussion that perceived by GPs and an increase of client satisfaction and knowledge by 15.47% perceived by patients. All the trained nurses satisfied with their performance and perceived the improvement of knowledge, skills and attitude in delivering excellent service.
The CHN practice in PHU has enhanced. The effectiveness of model to improve quality of nursing practice in PHU is promising. Nursing Model and standard of care as well as well trained staff are among the significant components of the effectiveness and excellent of nursing care practice.
Neuman, B., Fawcett, J. (2002). The Neuman Systems Model (4th ed.). New Jersey: Prentice Hall.
Ume-Nwagbo, P.N., DeWan, S.A., Lowry, L.W. (2006).Using the Neuman Systems Model for Best Practices. Nursing Science Quarterly. 19 (1), Jan 2006, P31-35.
Objectives: 1. To apply NSM in public health units for strengthening quality community health nursing care 2. To examine the effectiveness of the NSM from patients and health providers perspectives Research about Spiritual Care in Nursing and Social Work in The Netherlands Showed: Spiritual Care is Obvious, but not Natural
Dr AE Schep-Akkerman Dr RR van Leeuwen Reformed University of Applied Sciences Knowledge Network of Health Care and Spirituality Zwolle, Netherlands
Study purpose. To investigate spiritual care by care nurses and social workers in daily practice in the Netherlands.
Conceptual framework. The description of spiritual care we use is “to meet the spiritual needs of their patients and clients”, based on the definition of spirituality “the religious and/or existential mode of human functioning, including experiences and questions of meaning and purpose”.
Methodology. An online questionnaire was set up, with questions about personal spirituality, spirituality in work and demographic characteristics. Answers were calculated as percentages of the total group.
Results. 372 nurses and 46 social workers completed the questionnaire, mostly women and Christians. In theory, three quarter of all nurses and two third of all social workers state it is part of their job to notice spiritual needs of their patients/clients. In both groups, about one third say it is also a task to help patients/clients in these needs. Only a few respondents think they have no task in spiritual care. In practice, two third of all nurses and half of all social workers spoke about spiritual needs with patients/clients. Ten percent of all respondents did not practice any spiritual care last month. However, there are a lot of barriers influencing the providing of spiritual care.
Discussion. There is a gap between theory and practice: spiritual care is obvious, but (sad to say) not natural. There is provision of spiritual care, but nurses and social workers feel there are a lot of barriers. How do nurses and social workers ‘learn’ to provide spiritual care?
Implications. There have to be more attention to spiritual care in educational programmes to close the gap, and to stimulate the right attitude in nurses and social workers. Because spiritual care is about ‘being there’, about listening to and make contact with the patient/ client.
Participant outcome: Factors that play a role in providing spiritual care seems to be age and personal spirituality.
[Note: This abstract was accepted for presentation but presenters will not be able to attend the Symposium.]
Professional Nursing Practice and the Neuman Systems Model’s Created Environment
Barbara F. Shambaugh, EdD, RN Acting Director, PhD Program University of Phoenix Brookline, Massachusetts USA
In response to the continuing nursing shortage, nurse executives are turning to the American Nurses Association program of Magnet Certification for relief. Certification is a tool useful for the recruitment, retention, development and promotion of professional nursing services. Magnet Status provides a framework to address the needed development of an environment conducive to nursing practice in health care organizations.
The 14 Forces of Magnetism include leadership, organizational structure, management, and quality among the criteria required to achieve certification. Many health care organizations received certification, and many more institutions are in process. Professional development and professional models of care are critical indicators for creating an environment of professional nursing that supports nurses and managers alike.
Professional models of care, as depicted by the created environment of the Neuman Systems Model, support the linkage and collegiality needed between management and staff in a nursing department. The creation of one model of practice used by management and staff supports an environment of enhanced professionalism and a more seamless communication between both roles. The model provides the structure for active evidence-based practice. This wholistic approach, and common commitment to excellence will enhance managerial excellence, theory based care, and professional growth.
Neuman Systems Model and the Preterm Infant
Gayle Thear BSN, RNC, NE-BC Patient Care Manager NICU St Luke’s Hospital & Health Network Bethlehem, Pennylvania & Nancy Johnston PhD, CRNP Assistant Professor of Nursing Cedar Crest College Allentown, Pennylvania USA
Purpose: To test application of Neuman’s Systems Model in a neonatal intensive care unit to a premature infant’s growth and development.
Conceptual framework: The Neuman Systems Model in synergy with Als (1982) Synactive Theory of Development provided a framework for family-centered nursing care of a premature infant in a neonatal intensive care unit.
The participant will: 1. Explore a conceptual model based on Neuman focusing on an anxious family unit in the NICU. 2. Describe integration of Neuman Systems Model and Synactive Theory to guide nursing practice for the preterm infant.
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