Description
In 1970 Betty Neuman developed a model known as the Neuman Systems Model (NSM). This model was developed as a teaching aid, to serve as a “framework to view nursing comprehensively within various contexts” (Smith, 2020, p.165). The concept of the NSM is the client is an open system, interacting and functioning in an environment, while responding to internal and external stressors. The response to these environmental stressors are looked at, and nursing interventions are implemented to help restore balance to the system in a way best geared towards that individual (Smith, 2020).
The client system or the core, is surrounded by three lines of defense. These lines of defense are the normal line of defense, the flexible line of defense and the line of resistance. The normal line reflects a typical response of the client in their usual state of wellness. Outside, is the flexible line of defense which seeks to eliminate symptoms and reactions the client system experiences in response to a stressor. The flexible line acts to protect the normal line of defense from such penetrating factors. On the contrary, within the normal line is the line of resistance, represents the protection and stabilization of the core when a stressor has achieved penetration, putting the whole system in jeopardy (Smith, 2020.) Neuman’s NSM model has three levels of prevention to restore the integrity of these defense lines.
Following the metaparadigm of nursing, the person in the NSM is the client. The client is can be representative of an individual, a family, a community, or social problem. The environment is inclusive of internal and external stressors, and how these stressors relate to the client system. The NSM defined health as the overall wellness of the client system. When homeostasis occurs within the system, wellness is achieved; disruption in this would indicate the presence of illness (Petiprin, 2023). According to the NSM, the role of nursing is to implement interventions to reduce stress and restore balance to the whole client system (Petiprin, 2023). A nurse’s role is to implement interventions to restore stability to the client system. This can be achieved with the use of the nursing process through nursing diagnosis, nursing goals, and nursing outcomes.
In my current role as an ICU nurse, we are constantly analyzing a patient’s condition, identifying nursing diagnoses, and finding realistic goals and appropriate interventions to help patients reestablish stability. Environmental stressors such as bright lights, alarms, machines, etc., play a large role in disrupting a patient’s core system. A lot of these environmental stressors are unfortunately things we cannot change in a critical care setting. What we as nurse’s can do is incorporate the client’s support system as the flexible line of defense to reduce the patient’s response to the environmental stressors. Delirium is commonly seen in critical care patients; this is an example of a line of resistance where environmental stressors have disrupted the patient’s whole system. The incorporation of support systems can help to reestablish a normal line of defense in this situation as well. The critical care nurse’s ability to accurately and timely assess environmental stressors and implement appropriate interventions will give the patient the greatest opportunity to achieve stability to their core system.
As an advanced practice nurse, the framework of NSM can help to identify potential stressors, how they will affect the patient, and how we as a provider can prevent this. As an APN working in a primary care setting for example, it is important to understand the patients’ potential psychological stressors, financial stressors, environmental stressors, support system issues. All of these factors can interfere with the individual’s ability to be in an optimal state of wellness. In a primary care setting, an APN can collaborate with the patient to implement primary, secondary and tertiary preventions for these interventions (Smith, 2020). An example of this could be a young patient who resides in a home with family members who live sedentary lifestyles and have poor eating habits. Primary means of prevention could be to educate the patient on healthy food choices, benefits of exercise, and potential consequences of unhealthy lifestyle choices. Secondary prevention would be early screenings for diabetes, obesity, hypertension etc. Tertiary would unfortunately be if the patient was diagnosed with type 2 diabetes for example, implementing a treatment plan.
The client is an open system, interacting and functioning in an environment, while responding to internal and external stressors. The NSM focuses attention to prevention as intervention to attain optimal system stability. In summary, wellness is achieved when the energy of the system is greater than the energy needed to maintain the functions of the system.
References.docx
In reply to B
Hi Brittany,
