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TheoreticalFoundationsofNursing(/)

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TheNeumanSystemsModel

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The Neuman Systems Model views the client as an open system that responds to stressors in the
environment.Theclientvariablesarephysiological,psychological,sociocultural,developmental,andspiritual.
The client system consists of a basic or core structure that is protected by lines of resistance. The usual
level of health is identified as the normal line of defense that is protected by a flexible line of defense.
Stressors are intra, inter, and extrapersonal in nature and arise from the internal, external, and created
environments.Whenstressorsbreakthroughtheflexiblelineofdefense,thesystemisinvadedandthelines
of resistance are activated and the system is described as moving into illness on a wellnessillness
continuum. If adequate energy is available, the system will be reconstituted with the normal line of defense
restoredat,below,oraboveitspreviouslevel.
Nursing interventions occur through three prevention modalities. Primary prevention occurs before the
stressor invades the system secondary prevention occurs after the system has reacted to an invading
stressor and tertiary prevention occurs after the system has reacted to an invading stressor and tertiary
preventionoccursaftersecondarypreventionasreconstitutionisbeingestablished.

MajorConcepts

Subconcepts

Humanbeingisviewedasanopensystemthat
interactswithbothinternalandexternalenvironment
forcesorstressors.Thehumanisinconstant
change,movingtowardadynamicstateofsystem
stabilityortowardillnessofvaryingdegrees.

Stressors
Astressorisanyphenomenonthatmightpenetrate
boththeflexibleandnormallinesofdefense,
resultingineitherapositiveornegativeoutcome.

Theenvironmentisavitalarenathatisgermaneto Intrapersonalstressorsarethosethatoccurwithin
thesystemanditsfunction.Theenvironmentmaybe theclientsystemboundaryandcorrelatewiththe
viewedasallfactorsthataffectandareaffectedby
internalenvironment.
thesystem.
Interpersonalstressorsoccuroutsidetheclient
Theinternalenvironmentexistswithintheclient
systemboundary,areproximaltothesystem,and
system.Allforcesandinteractiveinfluencesthatare haveanimpacttothesystem.
solelywithinboundariesoftheclientsystemmakeup
thisenvironment.
Extrapersonalstressors alsooccuroutsidetheclient
systemboundariesbutareatagreaterdistance
Theexternalenvironmentexistsoutsidetheclient
fromthesystemthanareinterpersonalstressors.
system.
Anexampleissocialpolicy.
Healthisdefinedastheconditionordegreeof
systemstabilityandisviewedasacontinuumfrom
Stability
wellnesstoillness.Whensystemneedsaremet,
optimalwellnessexists.Whenneedsarenot
Astateofbalanceorharmonyrequiringenergy
satisfied,illnessexists.Whentheenergyneededto exchangesastheclientadequatelycopeswith
supportlifeisnotavailable,deathoccurs.
stressorstoretain,attain,ormaintainanoptimal
Theprimaryconcernofnursingistodefinethe
levelofhealththuspreservingsystemintegrity.
appropriateactioninsituationsthatarestress
relatedorinrelationtopossiblereactionsoftheclient DegreeofReaction
orclientsystemtostressors.Nursinginterventions
areaimedathelpingthesystemadaptoradjustand
Theamountofsysteminstabilityresultingfrom
toretain,restore,ormaintainsomedegreeofstability stressorinvasionofthenormallineofdefense.
betweenandamongtheclientsystemvariablesand
environmentalstressorswithafocusonconserving Entropy
energy.
Aprocessofenergydepletionanddisorganization

movingthesystemtowardillnessorpossibledeath.
OpenSystem

Negentropy

Asysteminwhichthereisacontinuousflowofinput
andprocess,outputandfeedback.Itisasystemof
organizedcomplexity,whereallelementsarein

Aprocessofenergyconservationthatincreases
organizationandcomplexity,movingthesystem
towardstabilityorahigherdegreeofwellness.

interaction.
Input/output

BasicStrictureandEnergyResources
Thebasicstructure,orcentralcore,ismadeupof
thosebasicsurvivalfactorscommontothespecies.
Thesefactorsincludethesystemvariables,genetic
features,andstrengthsandweaknessesofthe
systemparts.

Thematter,energy,andinformationexchanged
betweenclientandenvironmentthatisenteringor
leavingthesystematanypointintime.
Reconstitution
Thereturnandmaintenanceofsystemstability,
followingtreatmentofstressorreaction,whichmay
resultinahigherorlowerlevelofwellness.

Clientvariables
Preventionasintervention
Newmanviewstheindividualclientholisticallyand
considersthevariablessimultaneouslyand
comprehensively.
Thephysiologicalvariablereferstothestructureand
functionsofthebody.
Thepsychologicalvariablereferstomental
processesandrelationships.
Thesocioculturalvariablereferstosystemfunctions
thatrelatetosocialandculturalexpectationsand
activities.
Thedevelopmentalvariablereferstothose
processesrelatedtodevelopmentoverthelifespan.
Thespiritualvariablereferstotheinfluenceof
spiritualbeliefs.
Flexiblelineofdefense
Aprotectiveaccordionlikemechanismthat
surroundsandprotectsthenormallineofdefense
frominvasionbystressors.

Interventionmodesfornursingactionand
determinantsforentryofbothclientandnurseinto
thehealthcaresystem.
Primarypreventionoccursbeforethesystemreacts
toastressoritincludeshealthpromotionand
maintenanceofwellness.Primaryprevention
focusesonstrengtheningtheflexiblelineofdefense
throughpreventingstressandreducingriskfactors.
Thisinterventionoccurswhentheriskorhazardis
identifiedbutbeforeareactionoccurs.Strategies
thatmightbeusedincludeimmunization,health
education,exercise,andlifestylechanges.
Secondarypreventionoccursafterthesystem
reactstoastressorandisprovidedintermsof
existingsymptoms.Secondarypreventionfocuses
onstrengtheningtheinternallinesofresistanceand,
thus,protectsthebasicstructurethrough
appropriatetreatmentofsymptoms.Theintentisto
regainoptimalsystemstabilityandtoconserve
energyindoingso.Ifsecondarypreventionis
unsuccessfulandreconstitutiondoesnotoccur,the
basicstructurewillbeunabletosupportthesystem
anditsinterventions,anddeathwilloccur.

Normallineofdefense
Anadaptationallevelofhealthdevelopedovertime
andconsiderednormalforaparticularindividual
clientorsystemitbecomesastandardforwellness
deviancedetermination.
Linesofresistance
Protectionfactorsactivatedwhenstressorshave
penetratedthenormallineofdefense,causinga
reactionsynptomatology.(Neuman,1995)

Tertiarypreventionoccursafterthesystemhas
beentreatedthroughsecondaryprevention
strategies.Itspurposeistomaintainwellnessor
protecttheclientsystemreconstitutionthrough
supportingexistingstrengthsandcontinuingto
preserveenergy.Tertiarypreventionmaybeginat
anypointaftersystemstabilityhasbeguntobe
reestablished(reconstitutionhasbegun).Tertiary
preventiontendtoleadbacktoprimaryprevention.
(Neuman,1995)

Assumptions
Eachclientsystemisunique,acompositeoffactorsandcharacteristicswithinagivenrangeofresponses.
Manyknown,unknown,anduniversalstressorsexist.Eachdiffersinitspotentialfordisturbingaclients
usualstabilitylevelornormallineofdefense.Theparticularinterrelationshipsofclientvariablesatanypointin
timecanaffectthedegreetowhichaclientisprotectedbytheflexiblelineofdefenseagainstpossible
reactiontostressors.
Eachclient/clientsystemhasevolvedanormalrangeofresponsestotheenvironmentthatisreferredtoasa
normallineofdefense.Thenormallineofdefensecanbeusedasastandardfromwhichtomeasurehealth
deviation.
Whentheflexiblelineofdefenseisnolongercapableofprotectingtheclient/clientsystemagainstan
environmentalstressor,thestressorbreaksthroughthenormallineofdefense.
Theclient,whetherinastateofwellnessorillness,isadynamiccompositeoftheinterrelationshipsofthe
variables.Wellnessisonacontinuumofavailableenergytosupportthesysteminanoptimalstateofsystem
stability.
Implicitwithineachclientsystemareinternalresistancefactorsknownaslinesofresistance,whichfunction
tostabilizeandrealigntheclienttotheusualwellnessstate.
Primarypreventionrelatestogeneralknowledgethatisappliedinclientassessmentandintervention,in
identificationandreductionormitigationofpossibleoractualriskfactorsassociatedwithenvironmental
stressorstopreventpossiblereaction.
Secondarypreventionrelatestosymptomatologyfollowingareactiontostressors,appropriaterankingof
interventionpriorities,andtreatmenttoreducetheirnoxiouseffects.
Tertiarypreventionrelatestotheadjustiveprocessestakingplaceasreconstitutionbeginsandmaintenance
factorsmovetheclientbackinacircularmannertowardprimaryprevention.
Theclientasasystemisindynamic,constantenergyexchangewiththeenvironment.(Neuman,1995)

Strengths/Weaknesses
Newmanreportsthatthemodelwasdesignedbutcanbeusedbyotherhealthdisciplines,whichcanbe
viewedaseitherastrengthorweakness.Asastrength,ifmultiplehealthdisciplinesusethemodel,a

consistentapproachtoclientcarewouldbefacilitated.Asaweakness,ifthemodelisusefultoavarietyof
disciplines,itisnotspecifictonursingandthusmaynotdifferentiatethepracticeofnursingfromthatofother
disciplines.
Strengths:
Themajorstrengthofthemodelisitsflexibilityforuseinallareasofnursingadministration,education,and
practice.
Neumanhaspresentedaviewoftheclientthatisequallyapplicabletoanindividual,afamily,agroup,a
community,oranyotheraggregate.
TheNeumanSystemsModel,particularlypresentedinthemodeldiagram,islogicallyconsistent.
Theemphasisonprimaryprevention,includinghealthpromotionisspecifictothismodel.
Onceunderstood,theNeumanSystemsModelisrelativelysimple,andhasreadilyacceptabledefinitionsof
itscomponents.
Weakness:
Themajorweaknessofthemodelistheneedforfurtherclarificationoftermsused.Interpersonaland
extrapersonalstressorsneedtobemoreclearlydifferentiated.

Analysis
ThedelineationofNeumanofthreedefenselineswasnotclearlyexplained.Inreality,theindividualresist
stressorswithinternalandexternalreflexeswhichweremadecomplicatedwiththeformulationofdifferent
levelsofresistanceintheopensystemsmodelofNeuman.
Neumanmadementionofenergysourcesinhermodelaspartofthebasicstructure.Itcanbemoreofhelp
whenNeumanhasenumeratedallsourcesofenergythatsheispertainingto.Withsuch,newnursing
interventionsastotheprovisionofneededenergyoftheclientcanbeconceptualized.
Theholisticandcomprehensiveviewoftheclientsystemisassociatedwithanopensystem.Healthand
illnessarepresentedonacontinuumwithmovementtowardhealthdescribedasnegentropicandtoward
illnessasentropic.Heruseoftheconceptofentropyisinconsistentwiththecharacteristicsofentropywhich
isclosed,ratherthananopensystem.

(c)2011Gonzalo,A.Allrightsreserved

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