Applicability of the Neuman Systems Model to the Gerontology Nursing practice: a scoping review

Oliveira, Samara Gonçalves de; Caldas, Célia Pereira; Nicoli, Esther Mourão; Silva, Frances Valéria Costa e; Cardoso, Rosane Barreto; Lopes, Fernanda Maria do Vale Martins

doi:10.1590/1518-8345.6977.4224

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Revista Latino-Americana de Enfermagem

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Review Article • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.6977.4224 copy

Applicability of the Neuman Systems Model to the Gerontology Nursing practice: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to map scientific productions on the application of the Neuman Systems Model to the Nursing practice focused on health care for aged people.

Method:

a scoping review based on the methodology proposed by the Joanna Briggs Institute. Seven electronic databases were consulted. Regarding the eligibility criteria, the following were considered: Population - Aged people; Concept - Application of the Neuman Systems Model in the Nursing practice; and Research Context - Health services.

Results:

a total of 14 studies made up the sample. The data were analyzed and summarized into two categories: implementation of the Neuman Systems Model in hospital, institutional and outpatient settings; and use of the Neuman Systems Model in community and home environments.

Conclusion:

the application of Neuman Systems approach to the Gerontology Nursing practice, in different care scenarios, proved to be promising, considering aged people as comprehensive individuals with multiple dimensions. This perspective has shown adaptability and effectiveness in meeting the diverse needs of older adults, resulting in an improvement in their quality of life in old age.

Descriptors:
Aged; Health Services; Nursing; Nursing Theory; Nursing Care; Systems Theory

Highlights:

(1) It is possible to integrate the systemic approach into the Gerontology Nursing practice.

(2) The Systems Model covers aged people’s needs in an integrative way.

(3) Actions to strengthen aged people’s lines of defense and resistance are important.

(4) The Model favors the identification of potential and real stressors for older adults.

(5) Studies with a systemic approach are required to promote healthy aging.

Data sources	Search strategy	Quantitative scientific productions
MEDLINE via PubMed	(aged[MeSH] OR aged OR “aged patient” OR “aged subject” OR elderly OR “elderly population” OR “elderly patient” OR “elderly subject” OR senior OR “senior citizens” OR old OR “old-aged” OR “old people” OR “old person” OR “older people” OR “aged, 80 and over”[MeSH] OR “aged, 80 and over” OR “Oldest Old” OR “very elderly” OR “very old” OR “very elderly” OR eldest OR elder OR “middle aged”[MeSH] OR “middle aged”) AND (“neuman systems model” OR “neuman model” OR “neuman`s model” OR “neuman`s systems model”)	49
CINAHL	( (MH “Aged”) OR “aged” OR “elderly” OR ““elderly population”” OR “senior” OR ““senior citizens”” OR “old” OR ““old-aged”” OR ““old people”” OR ““older people”” OR “elder” OR “eldest” OR (MH “Aged, 80 and Over”) OR ““Aged, 80 and over”” OR ““Oldest Old”” OR (MH “Middle Age”) OR ““Middle Aged”” ) AND ( (MH “Neuman Systems Model”) OR “neuman systems model” OR ““neuman model”” OR ““neuman`s model”” OR ““neuman`s systems model”” )	40
Embase	(‘aged’/de OR ‘aged patient’ OR ‘aged people’ OR ‘aged person’ OR ‘aged subject’ OR ‘elderly’ OR ‘elderly patient’ OR ‘elderly people’ OR ‘elderly person’ OR ‘elderly subject’ OR ‘senior citizen’ OR ‘senior’ OR ‘senior citizens’ OR ‘aged’ OR ‘very elderly’/de OR ‘aged, 80 and over’ OR ‘very old’ OR ‘very elderly’ OR ‘middle aged’/de OR ‘middle age’ OR ‘middle aged’) AND (‘neuman systems model’/de OR ‘neuman model’ OR ‘neuman`s model’ OR ‘neuman`s systems model’ OR ‘neuman systems model’)	36
Web of Science	TS=((aged OR “aged patient” OR “aged subject” OR elderly OR “elderly population” OR “elderly patient” OR “elderly subject” OR senior OR “senior citizens” OR old OR “old-aged” OR “old people” OR “old person” OR “older people” OR “aged, 80 and over” OR “Oldest Old” OR “very elderly” OR “very old” OR “very elderly” OR eldest OR elder OR “middle aged” OR “middle age”) AND (“neuman systems model” OR “neuman model” OR “neuman`s model” OR “neuman`s systems model”))	20
Scopus	TITLE-ABS-KEY ( ( aged OR “aged patient” OR “aged subject” OR elderly OR “elderly population” OR “elderly patient” OR “elderly subject” OR senior OR “senior citizens” OR old OR “old-aged” OR “old people” OR “old person” OR “older people” OR “aged, 80 and over” OR “oldest old” OR “very elderly” OR “very old” OR “very elderly” OR eldest OR elder OR “middle aged” OR “Middle Age” ) AND ( “neuman systems model” OR “neuman model” OR “neuman`s model” OR “neuman`s systems model” ) )	59
Science Direct	(aged OR elderly OR “middle aged” OR “aged, 80 and over”) AND (“neuman systems model” OR “neuman model” OR “neuman`s model” OR “neuman`s systems model” OR “neuman systems model”)	112
LILACS	((mh:(“aged”) OR aged OR elderly OR “elderly population” OR senior OR “senior citizens” OR old OR “old-aged” OR “old people” OR “old person” OR “older people” OR elder OR eldest OR mh:(“aged, 80 and over”) OR “aged, 80 and over” OR “oldest old” OR mh:(“middle aged”) OR “middle aged”)) AND ((“neuman systems model” OR “neuman model” OR “neuman`s model” OR “neuman`s systems model”))	6

Category 1 - Implementation of the Neuman Systems Model in hospital, institutional and outpatient settings
Reference	Country/Year of Publication/ Data sources	Methodological approach/Type of study	Objectives	PCC ^* * PCC = Population, Concept and Context;
Weinberger SL ⁽ ¹²12. Weinberger SL. Analysis of a clinical situation using the Neuman Systems Model. Rehab Nurs. 1991;16(5):278-81. https://doi.org/10.1002/j.2048-7940.1991.tb01233.x https://doi.org/10.1002/j.2048-7940.1991... ⁾	United States/ 1991/ Rehabilitation Nursing	Qualitative/ Case report	To describe an analysis using the Neuman Systems Model to determine the effects of a colostomy on an 81-year-old client with cancer.	P ^† † P = Population; : An 81-year-old person diagnosed with bowel cancer and using a colostomy bag. C ^‡ ‡ C = Concept; : The study explored the concepts of intrapersonal, interpersonal and extrapersonal stressors, in addition to psychological, sociocultural and physiological client variables, as well as lines of defense and secondary prevention actions. C ^§ § C = Context : Hospital health service.
Potter ML, Zauszniewski JA ⁽ ¹³13. Potter ML, Zauszniewski JA. Spirituality, resourcefulness, and arthritis impact on health perception of elders with rheumatoid arthritis. J Holist Nurs. 2000;18(4):311-31. https://doi.org/10.1177/089801010001800403 https://doi.org/10.1177/0898010100018004... ⁾ .	United States/ 2000/ Journal of Holistic Nursing	Quantitative/ Correlational and cross-sectional study	To examine variables that reflect reactions to stress, lines of defense and resistance and the basic core of human beings in the context of the Neuman Systems Model in a sample of aged people.	P ^† † P = Population; : People aged at least 60 years old diagnosed with rheumatoid arthritis. C ^‡ ‡ C = Concept; : The study explored the concepts of client system variables (physiological, psychological, sociocultural, spiritual and developmental), lines of defense and resistance and the client’s basic core. C ^§ § C = Context : Hospital health service.
Butts JB ⁽ ¹⁴14. Butts JB. Outcomes of comfort touch in institutionalized elderly female residents. Geriatr Nurs. 2001;22(4):180-4. https://doi.org/10.1067/mgn.2001.117914 https://doi.org/10.1067/mgn.2001.117914... ⁾ .	United States/ 2001/ Geriatric Nursing	Quantitative/ Experimental study	To examine whether comforting touch improved perceptions of self-esteem, well-being and social processes, health status, life satisfaction and self-realization and faith or belief and self-responsibility of institutionalized aged women.	P ^† † P = Population; : Woman aged at least 65 years old. C ^‡ ‡ C = Concept; : The study explored the concepts of client system variables (physiological, psychological, sociocultural, spiritual and developmental) to examine whether comforting touch improved perceptions of self-esteem, well-being and social processes, health status, life satisfaction and self-realization and faith or belief and self-responsibility. C ^§ § C = Context : Two medium-sized nursing homes.
Lowry LW ⁽ ¹⁵15. Lowry LW. A Qualitative Descriptive Study of Spirituality Guided by the Neuman Systems Model. Nurs Sci Q. 2012;25(4):356-61. https://doi.org/10.1177/0894318412457052 https://doi.org/10.1177/0894318412457052... ⁾ .	United States/ 2012/ Nursing Science Quarterly	Qualitative/ Descriptive and interpretative	To explore the meaning of spirituality as described by older adults in various health states; to describe the relationship between spirituality and health; and to explain clients’ expectations for health professionals related to spirituality.	P ^† † P = Population; : People aged at least 60 years old. C ^‡ ‡ C = Concept; : The study used the concept of the “spirituality” variable from the Neuman Systems Model. C ^§ § C = Context : Nursing homes and Nursing care units.
Sousa JERB, Silva GRF, Luz MHBA, Pereira MLL ⁽ ¹⁶16. Sousa JERB, Silva GRF, Luz MHBA, Pereira MLL. Theoretical conceptions of Neuman associated with prevention of pressure ulcers: An experience report. Index Enferm. 2015;24(4):1-17. https://doi.org/10.4321/S113212962015000300007 https://doi.org/10.4321/S113212962015000... ⁾ .	Spain/ 2015/ Index de Enfermería	Qualitative/ Case report	To show how the use of Neuman’s Theory associated with the prevention of pressure injuries employing the Braden Scale as a clinical standard is effective in reducing the incidence of pressure injuries in intensive care units.	P ^† † P = Population; : A 94-year-old woman with acute respiratory failure, pneumonia and decompensated diabetes. C ^‡ ‡ C = Concept; : The study investigated client variables (physiological, psychological, sociocultural and developmental). In addition to that, it examined the nature and intensity of intrapersonal, interpersonal and extrapersonal stressors, considering their influence on the likelihood of these stressors emerging and reactions to them. It also analyzed the client’s interaction with environmental stressors, care strategies to maintain stability of the client system and achieve the highest possible level of overall client well-being. C ^§ § C = Context : Hospital care service (Intensive Care Unit).
Rosa PH, Beuter M, Benetti ERR, Bruinsma JL, Venturini L, Backes C ⁽ ¹⁷17. Rosa PH, Beuter M, Benetti ERR, Bruinsma JL, Venturini L, Backes C. Stressors factors experienced by hospitalized elderly from the perspective of the Neuman Systems Model. Esc Anna Nery Rev Enferm. 2018;22(4):e20180148. https://doi.org/10.1590/2177-9465-ean-2018-0148 https://doi.org/10.1590/2177-9465-ean-20... ⁾ .	Brazil/ 2018/ Anna Nery School Journal of Nursing	Qualitative/ Descriptive study	To describe the stressors experienced by hospitalized aged people from the perspective of the Neuman Systems Model	P ^† † P = Population; : People aged at least 60 years old hospitalized for more than five days. C ^‡ ‡ C = Concept; : The study explored the concepts of intrapersonal, interpersonal and extrapersonal client system stressors. C ^§ § C = Context : Hospital care service (Medical Clinic).
Benetti ERR, Beuter M, Rosa PH, Backes C, Jacobi CS, Oliveira FF ⁽ ¹⁸18. Benetti ERR, Beuter M, Rosa PH, Backes C, Jacobi CS, Oliveira FF. Characterization of hospitalized elderly people according to the Neuman Systems Model: contributions for nursing. Rev Enferm UFSM. 2021;11:e8. https://doi.org/10.5902/2179769242086 https://doi.org/10.5902/2179769242086... ⁾ .	Brazil/ 2021/ Revista de Enfermagem da Universidade Federal de Santa Maria	Qualitative/ Convergent Care Research	To characterize hospitalized aged people according to the dimensions proposed by the Neuman Systems Model.	P ^† † P = Population; : Hospitalized people aged at least 60 years old. C ^‡ ‡ C = Concept; : The study explored the Nursing Process based on this theoretical model, highlighting the concepts of: client variables (physiological, psychological, sociocultural and developmental); stressors; coping strategies related to stressors; and care actions to promote stability in the client’s system. C ^§ § C = Context : Hospital care service (Medical Clinic I; Medical Clinic II and Surgical Clinic).
Category 2 - Use of the Neuman Systems Model in community and home environments
Reference	Country/Year of Publication	Methodological approach	Objectives	PCC ^* * PCC = Population, Concept and Context;
Ross MM, Bourbonnais FF ⁽ ¹⁹19. Ross MM, Bourbonnais FF. The Betty Neuman Systems Model in nursing practice: a case study approach. J Adv Nurs. 1985;10(3):199-207. https://doi.org/10.1111/j.1365-2648.1985.tb00513.x https://doi.org/10.1111/j.1365-2648.1985... ⁾ .	United Kingdom/ 1985/ Journal of Advanced Nursing	Qualitative/ Case report	To describe how the Betty Neuman Systems Model is used in the practice employing a case report approach.	P ^† † P = Population; : A 66-year-old person recovering at home after hospitalization and treatment for a myocardial infarction. C ^‡ ‡ C = Concept; : The study explored the concepts of intrapersonal, interpersonal and extrapersonal stressors, lines of defense and lines of client’s system resistance; in addition to primary, secondary and tertiary intervention strategies to promote stability in the client’s system. C ^§ § C = Context : Home care service.
Ross MM, Helmer H ⁽ ²⁰20. Ross MM, Helmer H. A comparative analysis of Neuman’s model using the individual and family as the units of care. Public Health Nurs. 1988;5(1):30-6. https://doi.org/10.1111/j.1525-1446.1988.tb00557.x https://doi.org/10.1111/j.1525-1446.1988... ⁾ .	United States/ 1988/ Public Health Nursing	Qualitative/ Case report	To identify the similarities and differences between caring for an individual as a client and caring for a family as a client when using Betty Neuman’s Systems Model as a guide for the practice.	P ^† † P = Population; : An aged couple (63-year-old woman and 66-year-old man). C ^‡ ‡ C = Concept; : The study explored the concepts of intrapersonal, interpersonal and extrapersonal stressors, lines of defense and lines of client’s system resistance; in addition to primary, secondary and tertiary intervention strategies to promote stability in the client’s system. C ^§ § C = Context : Home care service.
Millard J ⁽ ²¹21. Millard J. Health visiting an elderly couple. Br J Nurs. 1992;1(15):772-3. https://doi.org/10.12968/bjon.1992.1.15.769 https://doi.org/10.12968/bjon.1992.1.15.... ⁾ .	United Kingdom/ 1992/ British Journal of Nursing	Qualitative/ Case report	To analyze the role of health visitors in engaging with the elderly population, examining how assessment tools can influence the client’s perceptions about obtaining information and the care/support offered.	P ^† † P = Population; : People aged at least 60 years old with Parkinson’s disease. C ^‡ ‡ C = Concept; : The study explored the concepts of intrapersonal, interpersonal and extrapersonal stressors, outlining short-, medium- and long-term care goals based on the client’s health needs through primary, secondary and tertiary prevention interventions. C ^§ § C = Context : Community health service.
Imamura E ⁽ ²²22. Imamura E. Amy’s Chat Room: health promotion programmes for community dwelling elderly adults. Int J Nurs Pract. 2002;8(1):61-4. https://doi.org/10.1046/j.1440-172x.2002.00349.x https://doi.org/10.1046/j.1440-172x.2002... ⁾ .	United States/ 2002/ International Journal of Nursing Practice	Qualitative/ Intervention study	To promote older adults’ understanding of chronic diseases; to inform them about proper nutrition and its impact on their health; to perform specific exercises for the elderly; and to ease building of supportive relationships among older adults.	P ^† † P = Population; : People aged at least 65 years old. C ^‡ ‡ C = Concept; : A multidimensional questionnaire based on the concepts of client variables (physiological, psychological, sociocultural, spiritual and developmental) was developed to assess individual and behavioral experiences and explore the participants’ health conditions. C ^§ § C = Context : Community health service.
Montano AR, Shellman J, Malcolm M, McDonald D, Rees C, Fortinsky R, Reagan L ⁽ ²³23. Montano AR, Shellman J, Malcolm M, McDonald DRC, Fortinsky R, Reagan L. A mixed methods evaluation of got care! Geriatr Nurs. 2020;41(6):822-31. https://doi.org/10.1016/j.gerinurse.2020.04.016 https://doi.org/10.1016/j.gerinurse.2020... ⁾ .	United States/ 2020/ Geriatric Nursing	Quanti-qualitative/ Parallel mixed-methods convergent design	To evaluate the relationship between an Interprofessional Collaborative Practice (IPCP) intervention for community-dwelling older adults, Geriatric Outreach, and Training with Care! (GOT Care!), and reduced Emergency Department (ED) visits for the 51 aged participants.	P ^† † P = Population; : People aged at least 65 years old living in the community identified as high risk, due to high use of emergency services or polypharmacy with multiple conditions. C ^‡ ‡ C = Concept; : The study used the concepts of client variables (physiological, psychological, sociocultural, spiritual and developmental), stressors, lines of defense, lines of resistance and primary, secondary and tertiary prevention strategies. C ^§ § C = Context : Community health service.
Larijani F, Fotokian Z, Jahanshahi M, Tabi SR ⁽ ²⁴24. Larijani F, Fotokian Z, Jahanshahi M, Tabi SR. Application of Neuman’s Systems Model on Anxiety of Older Adults Waiting for Colonoscopy. Nurs Midwifery Stud. 2021;10(4):236-42. https://doi.org/10.4103/nms.nms_77_20 https://doi.org/10.4103/nms.nms_77_20... ⁾ .	Iran/ 2021/ Nursing and Midwifery Studies	Quantitative	To evaluate the effect of the Neuman Systems Model on the anxiety of aged people waiting for a colonoscopy.	P ^† † P = Population; : People aged at least 60 years old fluent in Persian, who have not received anxiolytic or antipsychotic drugs in the last six months, no hearing or cognitive impairments, no history of severe stress in the last three months, no history of endoscopy or colonoscopy, and who achieved at least 50% of the total score on the Neuman Systems Model needs assessment checklist. C ^‡ ‡ C = Concept; : The study explored the concepts of client variables (physiological, psychological, sociocultural and developmental), potential and actual intrapersonal, interpersonal and extrapersonal stressors, goal setting, Nursing interventions and assessment, according to the Nursing Process supported by the Neuman Systems Model. C ^§ § C = Context : Home health care.
Pereira F, Bieri M, Martins MM, Del Río Carral M, Verloo H ⁽ ²⁵25. Pereira F, Bieri M, Martins MM, Del Río CM, Verloo H. Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals’ Perspectives. Nurs Rep. 2022;12(2):403-23. https://doi.org/10.3390/nursrep12020039 https://doi.org/10.3390/nursrep12020039... ⁾ .	Italy/ 2022/ Nursing Reports	Qualitative/ Descriptive study	To identify and categorize the stressors experienced and the recovery strategies adopted by aged people, their informal caregivers and health professionals in the medication management of older adults after hospital discharge.	P ^† † P = Population; : People aged at least 65 years old hospitalized in the last 90 days, managing at least five different medications daily. C ^‡ ‡ C = Concept; : The study explored the concepts of extrapersonal stressors and the extrapersonal reconstitution strategies adopted by aged people, their informal caregivers and health professionals in medication management after hospital discharge. C ^§ § C = Context : Home health care.

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[1] Corresponding author:
Samara Gonçalves de Oliveira E-mail: samarasog@gmail.com https://orcid.org/0000-0002-4532-9489