While both theorists (Roy and Neuman) define the metaparadigm concepts of person, environment, health, and nursing and use the reciprocal interaction worldview, their key assumptions are fundamentally different. They differ concerning their perspectives on the goal of nursing, health, and definition of the environment.
Goal of Nursing
In Roy’s adaptation model (RAM), the nursing goal is to support the client (an adaptive system) to adapt to the illness in the “four adaptive modes of physiological, self-concept, role function, and interdependence” (Julia, 2011, p. 71). It emphasizes the assessment of behavioral factors that shape adaptive abilities, interventions that reinforce coping mechanisms, and strengthening adaptive processes. In contrast, the goal in Neuman’s systems model (NSM) is to provide holistic health for the client through “retention, attainment, or maintenance of client system stability” (DeWan & Ume-Nwagbo, 2012, p. 33). The stability of the client system (a multi-dimensional system) is achieved through the removal of stressors – intrapersonal, interpersonal, and extrapersonal – that would compromise the normal line of defense (LOD).
Roy regards health as a process that patients utilize to attain their “maximum potential” irrespective of their disease states (Vera, 2014, para. 4). Nursing care focuses on reinforcing the patient’s adaptive responses, which manifest as adaptive or ineffectual behaviors, and the underlying stimulus (Vera, 2014). Neuman views health as a patient’s position on “a continuum that ranges from wellness to illness” (Melton, Secrest, Chien, & Andersen, 2011, p. 181). Therefore, nursing interventions should center on preserving system stability through preventive measures that protect the flexible LOD, reinforce resistance factors, and facilitate re-adaptation within the continuum.
Both theorists view the client as having a reciprocal relationship with his/her internal and external environments. However, Neuman introduces a ‘created environment’ that the patient produces sub-consciously and spontaneously as a protective mechanism. According to Wills and McEwen (2012), the created environment can force a person to be “intrapersonal, interpersonal, and extrapersonal” in nature (p. 83). Roy gives three forms of stimuli/factors that operate within the environment, namely, focal, contextual, and residual factors.
Differences in the Plan of Care
RAM’s nursing plan for Mr. Reynolds would be different from that of the NSM model. In RAM, the nurse would begin with a patient assessment. Level I assessment will cover the physiologic-physical mode, i.e., oxygenation (RR, BP=normotensive), nutrition (diabetic diet, BMI changes, bowel sounds), elimination, activity/rest (walking with crutches), etc. It will also cover the self-concept – anxiety about hip surgery, widower, estranged, and personal self (financial burden) – role performance, and interdependence modes. The level II assessment would involve evaluating Mr. Reynolds’ focal stimuli (fever), contextual stimuli (BMI), and residual stimuli (illness history – CAD and DM) before making a nursing diagnosis.
In contrast, in NSM, the nurse would start with nursing diagnosis, i.e., potential response to the stressor, for Mr. Reynolds. This reaction may be reduced intake, diarrhea, vomiting, nausea, low appetite, etc. (Reed, 2015). The next step would involve the formulation of nursing goals and rationales. For instance, the plan may seek to improve Mr. Reynolds’ dietary practices (goal) to manage the CAD and DM symptoms (rationale). The interventions would be assessing his vitals, pulse, respiration, and temperature and providing a diabetic diet. The signs/symptoms are evaluated throughout the patient’s hospitalization period to monitor his progress. For RAM a nursing diagnosis is made based on level II assessment results. The next step involves the formulation of nursing goals and interventions followed by evaluation.
DeWan, S., & Ume-Nwagbo, P. (2012). Using the Neuman systems model for best practices. Nursing Science Quarterly, 19(1), 31-35.
Julia, G. (2011). Nursing theories-The base for professional nursing practice. Norwalk, CT: Appleton and Lange.
Melton, L., Secrest, J., Chien, A., & Andersen, B. (2011). A community needs assessment for a SANE program using Neuman’s model. Journal of the American Academy of Nurse Practitioners, 13(4), 178-186.
Reed, P. (2015). The force of nursing theory guided-practice. Nursing Science Quarterly, 19(3), 225-232.
Vera, M. (2014). . Web.
Wills, M., & McEwen, M. (2012). Theoretical basis for nursing. Philadelphia, PA: Lippincott Williams & Wilkins