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Neuman's System Model

Neuman Systems Model Assumptions and Propositions Neuman developed her systems approach because she wanted to teach her nursing students to look at their clients holistically (Hood, 2010). She establishes the value of a systemsbased approach to holistic care of clients through the assumptions of the model. According to McEwen & Wills (2011), Neuman summarized 10 propositions or assumptions of the Neuman Systems Model (NSM) as follows: 1. Each client system is unique, a composite of factors and characteristics within a given range of responses. 2. Many known, unknown, and universal stressors exist. Each differs in its potential for disturbing a clients usual stability level or normal line of defense. The particular interrelationships of client variables at any point in time can affect the degree to which a client is protected by the flexible line of defense against possible reaction to stressors. 3. Each client/client system has evolved a normal range of responses to the environment that is referred to as a normal line of defense. The normal line of defense can be used as a standard from which to measure health deviation. 4. When the flexible line of defense is no longer capable of protecting the client/client system against an environmental stressor, the stressor breaks through the normal line of defense. 5. The client whether in a state of wellness or illness, is a dynamic composite of the interrelationships of the variables. Wellness is on a continuum of available energy to support the system in an optimal state of system stability. 6. Implicit within each client system are internal resistance factors known as lines of resistance, which function to stabilize and realign the client to the usual wellness state. 7. Primary prevention relates to general knowledge that is applied in client assessment and intervention, in

identification and reduction or mitigation of possible or actual risk factors associated with environmental stressors to prevent possible reaction. 8. Secondary prevention relates to symptomatology following a reaction to stressor, appropriate ranking of intervention priorities and treatment to reduce their noxious effects. 9. Tertiary prevention relates to adjustive processes taking place as reconstitution begins and maintenance factors move the client back in a circular manner toward primary prevention. 10. The client as a system is in dynamic, constant energy exchange with the environment (p. 141). These assumptions or propositions help to describe, explain and connect the concepts of the model. Metaparadigm and Major Concepts NSM depicts a systems perspective of the metaparadigm of nursing. The model defines all four elements of the metaparadigm which are human being, environment, health and nursing. NSM uses many major concepts to explain the way a person reacts to environmental stressors and establishes the importance of prevention as intervention. The connections among the concepts of human being, health, nursing and environment are repetitively mentioned throughout NSM. This paper will define the metaparadigm according to Neuman as well as describe many other major concepts of NSM. Human Being Human beings are combinations of physiological, psychological, sociocultural, developmental, and spiritual variables in interaction with the internal and external environment (Hood, 2010). Human beings are referred to as person or client system throughout NSM. The person is a multifaceted being made of up layers which represent each of the five variables. The first variable is physiological which refers to the bodys physicochemical structure and function

(Neuman & Fawcett, 2011). The second variable is psychological which refers to a persons mental and emotional aspects. The third variable is sociocultural which refers to relationships and sociocultural aspects. The fourth variable is spiritual which refers to how a persons spiritual beliefs influence them. The fifth and final variable is developmental which refers to a persons development throughout their lifespan (Neuman & Fawcett, 2011). NSM states that an individual, group or community may comprise the client system (Neuman & Fawcett, 2011). Environment NSM defines environment as the sum of the internal and external forces which are in constant interaction with a person (Neuman & Fawcett, 2011). The relationship between the environment and person is described as a dynamic one because it is frequently changing, affecting, and being affected by the person. According to NSM, human beings constantly encounter stressors from the internal, external, or a created environment (Hood, 2010). The environment within the client system is called the internal environment. The environment outside the client system is called the external environment. Neuman & Fawcett (2011) also identified the created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness (p. 19). The clients perception of the internal and external environments come together to form the created environment. Health NSM associates health to wellness. According to Neuman & Fawcett (2011), health is defined as a continuum; wellness and illness are at opposite ends. Health for the client is equated with optimal system stability that is the best possible wellness state at any given time (p. 24). The NSM defines wellness as the state in which all variables are in harmony with the whole of

the client (Neuman & Fawcett, 2011, p. 20). Maintenance of the client systems stability or wellness is directly related to energy conservation. If energy conservation occurs then the system moves toward stability or wellness and this process is called negentropy (Newman & Fawcett, 2011). The process of entropy occurs if energy is depleted. This causes the system to become less stable and illness or even death may occur (Newman & Fawcett, 2011). Nursing Neuman sees nursing as a distinctive profession that is concerned with maintaining client stability by assessing all of the variables which influence the response a client might have to a stressor in order to maintain wellness (McEwen & Wills, 2011). Nursing responds to the constant interaction of the client system with environmental stressors which creates disequilibrium. Nurses must give clients the opportunity to relieve stress in their own ways which is another way of saying nurses must tailor care to the specific client. It is important for nurses to assess the clients physiological, psychological, sociocultural status, development, and spirituality when determining the plan of care. The client should be involved in establishing goals for their plan of care. It is important to client care and health outcomes to develop nursing care interventions that bring the client back to a balanced level of wellness, and equip them to stay that way. Measurable outcomes should be determined and revised as needed. It is important to provide adequate educational information for retention and attainment of health upon discharge. Nurses should set the client up with community resources to help them maintain health. The NSM promotes the importance of prevention as intervention. Stressors Stressors cause changes in the state of health and well being of the person. These forces include the intrapersonal, interpersonal and extra-personal environmental factors which can

affect the persons normal line of defense and in turn affect the stability of the system (Hood, 2010). Intrapersonal factors include emotion and feeling. Interpersonal factors include role expectation. Extra-personal factors include lifes pressures such as financial or job-related pressures. Any environmental factor that could potentially break through the normal line of defense may be referred to as a stressor. The outcome of the interaction of stressors and the client system may be negative or positive. The disruption of a persons equilibrium leads to illness and may even result in death if not dealt with. This disruption of health causes the person to utilize defense mechanisms to relieve and handle the stress. Lines of Defense Lines of defense provide reactions and resistance to stressors (Hood, 2010). NSM describes the client system as concentric rings surrounding the core (Neuman & Fawcett, 2011). The concentric system from the center out is comprised of the core which is surrounded by the lines of resistance which are surrounded by the normal line of defense which is surrounded by the outermost layer, the flexible line of defense (Neuman & Fawcett, 2011). The flexible line of defense generates an adaptive response to stressors. If the flexible line of defense is unsuccessful in providing sufficient protection then the normal line of defense attempts to neutralize the stressor (Hood, 2010). The normal line of defense is the usual response of a human being to a stressor. It represents system stability over time and is considered to be the standard level of stability within the client system. If the stressor breaks through the normal line of defense then the lines of resistance are activated. The lines of resistance are unconscious protection factors that kick in when all other measures have failed. They protect the central core structure which makes life possible (Hood, 2010).

Culture, emotional state, level of energy, background, and beliefs of the client play a major role in stress reduction. Stress may be reduced through a normal line of defense such as exercise or meditation. If a person is unable to handle or reduce the stressors through normal lines of defense then the person uses unconscious lines of resistance. These are emotional defenses and physical symptoms may become apparent such as mood swings, emotional outburst, or difficulty breathing. At this time health is compromised (Hood, 2010). It is important for nurses to utilize interventions to reduce and eliminate the stress the patient is experiencing Interventions Neuman (2011) stresses the importance of the use of primary, secondary and tertiary levels of prevention as nursing interventions for retention, attainment, and maintenance of optimal client system wellness (p. 69). Primary prevention is applied in client assessment and intervention. It is responsible for the identification and reduction of possible or actual risk factors to promote health (McEwen & Wills, 2011). Secondary prevention occurs once a stressor has broken through the normal line of defense and is causing symptoms. It involves ranking intervention priorities and treatment to reduce the effects of the stressor (McEwen & Wills, 2011). Tertiary prevention occurs when the processes take place for reconstitution to begin and maintenance factors move the client back in a circular manner toward primary prevention (Neuman, 2011, p. 70).

References Hood, L. (2010). Conceptual bases of professional nursing (7th ed.). Philadelphia, PA: Lipincott, Williams & Wilkins. McEwen, M., & Wills, E. (2011). Theoretical basis for nursing (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Neuman, B., & Fawcett, J. (2011). The Neuman systems model (7th ed.). Upper Saddle River, NJ: Pearson.