The Neuman systems model is a holistic framework consisting of stressors and related reactions that has been applied to family caregivers of people with chronic diseases. Given the lack of recent critique, this study systematically analyzes and evaluates the model according to Fawcett and DeSanto-Madeya's 2013 framework, including examination of its testability and empirical adequacy for family caregivers of people with chronic diseases. Although the model has limited internal consistency and lacks parsimony, it has clear concepts and propositions that reflect the nursing metaparadigm, and it has demonstrated its social and theoretical significance, testability, and empirical and pragmatic adequacy.

Introduction Treatment adherence remains a major challenge in tuberculosis (TB) control, particularly in low- and middle-income countries like Indonesia. Although TB ​​treatment is provided free of charge, many patients still experience non-adherence due to various factors. This study examined the intrapersonal, interpersonal, and extra personal factors influencing TB treatment adherence using an integrated mixed-methods approach guided by Neuman's systems model. Methods We employed a simultaneous mixed-methods design. Quantitative data were collected from 185 TB patients using a structured questionnaire assessing cognitive, psychosocial, and health system-related variables. Bivariate correlations and multivariate regression analyses were conducted to analyze factors influencing adherence across Neuman's domains. Qualitative data were generated through in-depth interviews with six purposively selected patients and were analyzed thematically. Findings from both approaches were integrated through joint interpretation to identify convergent and complementary patterns within the theoretical framework. Results In the multivariate analysis, shame was a significant negative intrapersonal predictor of adherence, while knowledge showed a significant trend. Family and social support served as protective interpersonal factors. Extrapersonal variables, such as healthcare support, had limited effects in the regression models. Qualitative findings highlighted emotional exhaustion, stigma, family support, and systemic barriers such as long wait times and limited follow-up as key influences. Integrated analysis showed that internal emotional struggles were the most prominent barrier. Supportive relationships and responsive healthcare services were important buffers. Discussion TB treatment adherence is shaped by cognitive and emotional processes at the intrapersonal level, reinforced by interpersonal support, and constrained by extrapersonal conditions. Integrating quantitative and qualitative evidence through Neuman's systems model clarifies how shame and forgetfulness undermine adherence, and how motivation and social support strengthen patients' adherence to treatment. Structural challenges are less evident in the statistical models but are articulated in patient narratives, highlighting the responsiveness of the system. Conclusion TB treatment adherence is an interaction between individual, relational, and systemic stressors. Neuman's systems model provides a useful framework for understanding these dynamics. Interventions that strengthen emotional resilience, increase caregiver engagement, and incorporate digital health strategies may improve adherence in similar settings.

Purpose This study aims to explore the subjective experiences of people with multiple sclerosis (MS) using clean intermittent catheterization (CIC), guided by the Neuman Systems Model. It focuses on the relationship between disability, rehabilitation, and bladder management strategies. Materials and Methods A hermeneutic phenomenological approach was used with 15 people with MS who use clean intermittent catheterization at a university hospital. Data were collected through semi-structured interviews based on the Neuman Systems Model and analyzed using phenomenological hermeneutical methods, adhering to COREQ guidelines. Results Three main themes and eleven subthemes were identified: transitioning to clean intermittent catheterization, personal perspectives, and adaptation challenges. Participants reported multiple physical, psychological, and economic factors influencing clean intermittent catheterization adherence and functional independence. Conclusions This is the first qualitative study exploring clean intermittent catheterization use among people with MS from a rehabilitation perspective. The findings highlight the importance of individualized, structured support and regular follow-up to enhance self-care, autonomy, and adherence. The Neuman Systems Model provides a valuable framework for guiding future rehabilitation practices and patient-centered care.

Background: Inappropriate use of observation services for acute hospitalizations can lead to decreased reimbursement for care. Traditional evidence-based criteria are restrictive and do not consistently consider patients' preexisting conditions at the time of hospital arrival, highlighting the need for better utilization management (UM) and decision-making in assigning observation service versus inpatient admission. Objective: Guided by Neuman's Systems Model, the intervention aims to evaluate whether the implementation of an artificial intelligence (AI) tool in a UM registered nurse (RN) department can reduce health system observation service rates by enhancing the identification of patients' comorbidities, as well as improving the assessment of medical necessity and severity of illness for determining inpatient appropriateness in a large academic health system. Methods: Pre- and postimplementation observation versus inpatient volumes at discharge and observation-to-inpatient conversions were compared. Results: Postimplementation observation service discharge rates (12.75% monthly average) were lower compared with preimplementation observation service discharges (16.69% monthly average). UM RNs played a central role in the intervention, using the AI-generated Care Level Score to guide conversations with providers and advocate for appropriate patient placement. Conclusion: The implementations for nursing of an AI tool in the UM review process effectively reduced observation service discharge rates by improving the identification of comorbidities and enhancing the assessment of medical necessity. This approach demonstrated potential for better decision-making in recommending inpatient appropriateness and reducing observation service volume.

Patients with intellectual developmental disabilities face significant health care disparities, particularly in intensive care units, where the complexity of care and lack of tailored protocols exacerbate challenges. Nurses often encounter a knowledge gap in meeting these patients' unique needs, contributing to poorer outcomes. To explore the experiences of nurses caring for patients with intellectual developmental disabilities in an intensive care unit to inform strategies for improving the nursing care of this patient population. This study used a descriptive phenomenological design grounded in Edmund Husserl's philosophy and an interpretivist paradigm. Semistructured interviews were conducted via online videoconferencing with licensed nurses in the United States who had cared for patients with intellectual developmental disabilities in intensive care units within the past 5 years. Thematic analysis was used to identify key findings, contextualized using Betty Neuman's systems model to facilitate immediate bedside application for critical care nursing practice. Five themes emerged: equity and safeguarding, family or caregiver involvement, building ties with people with intellectual developmental disabilities, a need for specialized processes, and need for enhanced nursing support. The findings show that nurses and health care administrators should invest in specialized training and support for nursing staff. Caring for a vulnerable patient population that needs specialized care requires environmental and systemic adaptability as well as dedicated resources to be successful.

Diabetes care is a shared responsibility between the patient and their family members. The Neuman Systems Model offers a comprehensive approach aimed at promoting health. This study aimed to investigate the effect of family-centered care based on the Neuman Systems Model on the quality of life of patients with type 2 diabetes. Materials and Methods: This randomized controlled clinical trial was conducted on 78 patients. In the intervention group, based on the Neuman assessment form, patients' needs were identified and nursing diagnoses were determined. The required education was delivered to the active family member through eight sessions. The quality of life questionnaire was completed by both groups before and one month after the intervention. Data were analyzed using SPSS software (version 20) through descriptive and inferential statistics. Results: Before the intervention, the mean quality of life scores were 54.56±9.58 and 49.94±8.42 in the control and intervention groups, respectively. After the intervention, the scores were 51.43±10.66 and 60.15±6.76, respectively. Analysis of covariance showed a statistically significant improvement in the intervention group (P<0.001). Significant differences were observed between the two groups in the subdomains of disease complications and psychosocial impact (P<0.001). Conclusion: Given the effectiveness of family-centered care based on the Neuman Systems Model in improving the quality of life in patients with type 2 diabetes, it is recommended that structured educational programs based on this model be implemented for family members of diabetic patients. Empowering families in this way can ultimately enhance the patients' quality of life.

Background:Significant life events (SLEs) correlate with perinatal depression (PD) risk; however, little is known about this association in rural populations.Objectives:Using the Neuman systems model, we hypothesized that individuals with higher SLEs would have higher PD risk, and we evaluated this association with data collected from six of Utah’s diverse rural health districts.Design/Methods:This cross-sectional study included pregnant and postpartum individuals visiting six rural public health clinics who completed screening with the Edinburgh Postnatal Depression Scale (EPDS) and an 8-item SLE assessment in Spanish or English. Multinomial logistic regression assessed the association between SLEs (0, 1, and ⩾2) and PD risk status (EPDS ⩾9).Results:Data from 4245 screening surveys identified 2 primary racial groups: white (79.8%) and American Indian/Alaska Native (7.6%), with 20.2% of individuals identifying as Hispanic. Overall, 49.4% of individuals reported one SLE and 10.5% reported two or more SLEs. Significant predictors for PD risk included 1 SLE (OR = 1.84, 95% CI [1.56, 2.15]) or ⩾2 SLEs (5.18, 95% CI [4.31, 6.23]), regardless of racial/ethnic background.Conclusion:Screening for PD risk in a rural population should include an assessment of SLEs, given the relationship between the two. Improving culturally appropriate local resources to support individuals and their families during the childbearing year should be considered, particularly for those experiencing SLEs.

Introduction/Background: Asylum seekers in Dutch refugee Camps are often heavenly burdened with mental health problems triggered by the reason for fleeing and the circumstances during their travel to the Netherlands. This leads frequently to self-medication for relief and as a consequence to addiction, lower quality of life and social problems. In order to create an overview of existing knowledge of why so many asylum seekers experience psychiatric problems in Dutch refugee Camps, we reviewed the literature on influencing factors on mental health of asylum seekers with regard to the experience of the asylum seekers procedure and their stay in a refugee camp. Depression, addiction and perceived loneliness are among the “wicked “ problems which can be defined as: Wicked problems are problems with many interdependent factors making them seem impossible to solve. Because the factors are often incomplete, in flux, and difficult to define, solving wicked problems requires a deep understanding of the stakeholders involved, and an innovative approach provided by design thinking (Buchanan, 1992). Wicked problems create enormous cost in healthcare (Petrie & Peters, 2020). We advocate that all stakeholders within the system (policy-makers, providers, and patients) become comfortable with complexity as a determinant of health, and offer a tool for working with complexity, instead of trying to solve it. The movement to person-centered integrated care requires inter-organizational cooperation and service provision by domain-overarching networks and alliances. In the development to these networks, it is relevant to explore which accountability approaches are appropriate for local inter-organizational healthcare governance. Therefore, in a scoping review we studied the current state of knowledge and practice of accountability in healthcare in the Netherlands. Some leads were found in the literature which report on accountability in integrated care. There appears to be a rise in wicked problems in the web of accountability and changing contexts in healthcare delivery. However, there appears to be very little knowledge or even perspectives on accountability related to “wicked” problems and especially mental health problems. In this workshop we share values, perspectives, knowledge and experiences on wicked problems in integrated and personalized care. The target audience for this workshop consists of (PhD) students, researchers, educators, patients and professionals in health and social care. World café: we have three rounds of discussion and 6 table discussions based on the Neuman Systems Model Assessment and Intervention Tool (Neuman & Fawcett, 2011) All collected data will be collected and summarized by the organizing committee of this workshop. These will be shared with the participants and IFIC Academy with the intention of a yearly follow-up. Buchanan, R. (1992). Wicked problems in design thinking. Design issues, 8(2), 5-21. Petrie, S., & Peters, P. (2020). Untangling complexity as a health determinant: Wicked problems in healthcare. Health Science Inquiry, 11(1), 131-135.

The purpose of this essay is to discuss the evolution of definitions and descriptions of the concept of reconstitution from the perspective of the Neuman Systems Model. The essay progresses from dictionary definitions to descriptions given by Neuman to definitions and descriptions proposed by the authors of this essay. An important aspect of reconstitution is that it can be regarded as a process and as an outcome of an encounter with one or more stressors.

This study explores the growing use of the internet in medical and educational contexts, particularly in resource-limited settings, where digital media enhances health knowledge dissemination and healthcare worker training. Focusing on the integration of spiritual care in nursing, the research emphasizes nurses' critical role in addressing patients' spiritual needs amid diverse cultural and religious backgrounds. Employing a qualitative methodology with purposive sampling and follow-up interviews, the study identifies educational gaps in nurses' ability to provide spiritual care via internet-based tools. Framed within the Neuman systems model, the findings reveal a disconnect between the perceived importance of spiritual care and its practical implementation, highlighting insufficient training. The study concludes that nurses require education in both spiritual concepts and technological proficiency to effectively meet patients' spiritual needs through digital platforms.

In this study, we explored the impact of the Nursing Pregnant Education and Counseling Program, grounded in the Neuman Systems Model, on stress, coping, and birth outcomes for high-risk pregnant women susceptible to pre-term labor. The study has a pretest-posttest quasi-experimental design. Participants were split into two groups: one undergoing the Nursing Pregnant Education and Counseling Program (n=30), and the other receiving standard clinical care(n=30). We found a significant difference in stress perception and coping scores between women in the intervention and control groups, favoring the intervention group. Moreover, we observed a notable rise in full-term deliveries in the experimental group, along with a decreased rate of complications for babies compared to the control group. Use of this program for high-risk pregnant women resulted in reductions in maternal stress, improved use of active coping strategies, and favorable impacts on birth outcomes.

to identify the stressors experienced by informal caregivers based on Betty Neuman's Systems Model. this descriptive, qualitative study was conducted with informal caregivers of older adults registered and assisted by an institution in Presidente Prudente, São Paulo. Data were collected in October 2023 through audio-recorded semi-structured interviews and subjected to thematic content analysis. the 12 participating caregivers were between 30 and 59 years old. Conditions such as sleep deprivation, physical exhaustion, lack of support, financial hardship, and compromised health are examples of stressors experienced, which impacted caregivers' ability to cope with care demands without compromising their physical and emotional health. interventions that promote balance, mental health, and strengthening caregivers' support networks can help them find and use more effective coping and self-regulation mechanisms.

Introduction: Nutrition in old age was recognized as a key determinant of well-being and autonomy. Deficiencies and excesses in nutrition coexisted in older adults, with effects on morbidity, functionality, and quality of life. From a systems perspective, Betty Neuman's model allowed for an understanding of the interaction between the individual and the environment, placing prevention and system stability as goals of care. Within this framework, the aim was to describe the quality of dietary practices and identify their main determinants. Development: The study addressed eating habits as a result of interrelated factors: psychological (emotional state, stress), socioeconomic (income, family support, advertising), environmental (accessibility, portion size, eating in company), and physiological (hunger/satiety, senses, age). The quality of the practice was defined as adherence to specific recommendations and needs, incorporating diversity, balance, safety, and affordability. Critical requirements for older adults were reviewed—high biological value proteins, vitamins B12 and B6, calcium, magnesium, fiber, and water—and malnutrition (undernutrition, overweight/obesity, sarcopenia) was characterized. The nutritional assessment included dietary history and anthropometric and functional indicators. Based on Neuman's model, behavior modification and nutrition education strategies were described, along with community actions to improve access and affordability, and the inclusion of adapted physical activity as an adjunct. Conclusions: It was concluded that intervening in the nutrition of older adults required an integrated, person-centered approach based on Neuman's Systems Model. Prioritizing systematic nutritional screening, protein-micronutrient prescription, continuing education with family support, and improvements in the food environment projected benefits on autonomy and quality of life. It was recommended that cost-effectiveness be evaluated and interventions be adapted to local heterogeneities.

In this essay, we discuss the definition and interpretation of stressors from the perspective of the Neuman Systems Model. A distinctive aspect is the emphasis on the client system's perception of each stressor as beneficial (positive), noxious (negative), or both beneficial and noxious. The client system's perceptions of the stressors determine the wellness goals that are needed and guide the selection of necessary prevention-as-intervention strategies for achieving those goals. Several examples of stressors are included, as are two case studies.

Aim: The aim of this study is to identify nursing models used in doctoral theses in psychiatric and mental health nursing. Material and Methods: In this descriptive-type retrospective document analysis study, theses in mental health and psychiatric nursing departments of health sciences institutes were reviewed at the National Thesis Center of the Council of Higher Education on from September to October 2023. The study was completed with 14 doctoral theses. Word and Excel programs were used to record and analyze data. Results: The Roy Adaptation Model and then the Neuman Systems Model were mostly used in doctoral theses. It was determined that four theses were randomized controlled, and six theses were done within the scope of community mental health nursing when the sample group was examined. Conclusions: The Roy Adaptation Model has positive effects on issues such as emotional expression, self-esteem, and treatment areas. As a sample group, there was a tendency towards preventive mental health services. Experimental designs with control groups were used in doctoral theses, and four theses were determined to be randomized controlled.

Because nursing theory is integral to effective nursing practice, education, and research, today's faculty are expected to weave nursing theory throughout the nursing curricula at both advanced and entry academic levels. However, incorporating nursing theory across all courses may be unfamiliar for many faculty. In this article, a senior-year elective course in forensic nursing included in a prelicensure baccalaureate curriculum with a Neuman Systems Model focus is presented. Suggested forensic nursing metaparadigm concepts, a possible schedule of topics and activities, and samples of Neuman Systems Model-based assignments are provided. This example could easily be adapted to other nursing theories and/or to other courses across the curriculum. Also emphasized is the importance of nurses providing trauma-informed care for all clients and reinforces the value of accurate evidence collection techniques and documentation. Finally, this course offers students a view of forensic nursing as a viable career choice.

Bu çalışmanın amacı, infertilite tanısı olan bir kadına Neuman Sistemler Modeli doğrultusunda uygulanan hemşirelik bakımının açıklanmasıdır. Bu çalışma bir olgu sunumudur. Çalışmanın verileri ve olgunun hemşirelik bakımı katılımcı ile üç kez derinlemesine görüşme yapılarak uygulanmıştır. Görüşmeler esnasında Neuman Sistemler Modeli’ne uygun olarak Neuman tarafından geliştirilmiş yarı yapılandırılmış soru yönergesi kullanılmıştır. Çalışmada yer alan kadın hasta, mahremiyetinin korunması amacıyla “Gizem” ismiyle kodlanmıştır. Bulgularımız Gizem Hanım’ın fizyolojik, psikolojik, sosyokültürel, gelişimsel ve spiritüel alanlarında kişi içi, kişilerarası ve kişi dışı stresörlerinin olduğunu; en çok psikolojik, sosyokültürel ve gelişimsel alanlarda stres yaşadığını ortaya çıkarmıştır. Gizem Hanım’ın algıladığı stresörlere yönelik esnek savunma hattının aktive olduğu, ancak kullandığı baş etmelerin etkisiz ve sınırlı baş etme yöntemleri olması nedeniyle sorunun çözülemediği belirlenmiştir. Sorunun çözülememesi nedeniyle stresörlerin normal savunma hattına giriş yaptığı ve sistemde temel yanıt tepkisinin ortaya çıktığı belirlenmiştir. Bu nedenle Gizem Hanım’a ikincil ve üçüncül koruma kapsamında belirlenen hemşirelik girişimleri uygulanmıştır. Neuman Sistemler Modelinin; infertilite sorunu yaşayan hastaların deneyimledikleri stresi ve stresle baş etmelerini belirlemede çok boyutlu bir çerçeve sağladığı, sorunların çözümünde bütüncül bir yaklaşım sunduğu düşünülmektedir. Bu nedenle, toplumsal bir olgu olan ve hem kadını hem erkeği her anlamda oldukça fazla etkileyen infertilite problemine bağlı yaşanan sorunların olabildiğince hızlı bir şekilde tanımlanması ve çözümüne yönelik etkili müdahalelerin geliştirilmesi açısından Neuman Sistemler Modeli’nin infertilite hastalarına bakım veren hemşireler tarafından kullanılmasının önemli olduğu düşünülmektedir.

Aggression and violence influence nurse-client relationships and the quality of care provided, and just as important, they also influence the nurses' physical and emotional well-being. The Neuman systems model is utilized to define and understand factors that contribute to aggressive and violent behavior and for the purposes of providing a systematic approach to the prevention and management of stressors leading to aggression and violence.

Children with medical complexity are an increasing population with frequent use of intensive care services within hospitals. As children's health improves, they are often transferred to a general unit before being discharged to home. This transition often leads to an acute decline in health, resulting in emergent interventions. Betty Neuman's systems model provides the foundation to guide prevention interventions on stress mitigation to promote stability. An evidence-based transition bundle of care may be a valuable tool to prevent stress at the time of transfer from the intensive care unit and prevent deterioration.

In the article that follows the authors present information focused on nursing care delivery involving Neuman systems theory and improving the stress and stability. The authors then follow up with a clinical scenario which utilizes the Neuman system model as a means to prevent and ameliorate aggression and violence. The structure and evidence guided by Betty Neuman's systems model centers on managing and reducing stresses and working towards reconstitution. The thoughts contained in this article highlight some considerations regarding the importance of truth and truth for the moment for the nursing discipline.