Was born in 1924 and grew up on a farm in Ohio.

Her rural background helped her develop a compassion for people in need, which has been evident throughout her career. She completed her initial nursing education with double honors at People Hospital School of Nursing (now General hospital) She completed a doctoral degree in clinical psychology from Pacific Western University in 1985 (B. Neuman, personal communication, June 3, 1984).

Health is a condition in which all parts and subparts are in harmony with the whole of the client.

BASIC ASSUMPTION

Each client system is unique, a composite of factors and characteristics within a given range of responses contained within a basic structure. Many known, unknown, and universal stressors exist. Each differ in its potential for disturbing a clients usual stability level or normal LOD (Line of Defence). The particular inter-relationships of client variables at any point in time can affect the degree to which a client is protected by the flexible LOD against possible reaction to stressors. Each client/ client system has evolved a normal range of responses to the environment that is referred to as a normal LOD. The normal LOD can be used as a standard from which to measure health deviation.

 When the flexible LOD is no longer capable of protecting the client/ client system against an environmental stressor, the stressor breaks through the normal LOD The client whether in a state of wellness or illness, is a dynamic composite of the inter-relationships of the variables. Wellness is on a continuum of available energy to support the system in an optimal state of system stability. Implicit within each client system are internal resistance factors known as LOR, which function to stabilize and realign the client to the usual wellness state. Primary prevention relates to G.K. that is applied in client assessment and intervention, in identification and reduction of possible or actual risk factors.

 Secondary prevention relates to symptomatology following a reaction to stressor, appropriate ranking of intervention priorities and treatment to reduce their noxious effects. Tertiary prevention relates to adjustive processes taking place as reconstitution begins and maintenance factors move the back in circular manner toward primary prevention. The client as a system is in dynamic, constant energy exchange with the environment.

 Nursing Diagnosis - based on necessity of a thorough assessment and with consideration given to five variables in three stressor areas. Nursing Goals - these must be discussed with the patient and take account of patient's and nurse's perceptions of variance from wellness Nursing Outcomes - considered in relation to the five variables and achieved through primary, secondary and tertiary interventions.

3 STAGE NURSING PROCESS

MAJOR CONCEPTS

The Neuman Systems Model is a dynamic, open, system approach to client care originally develop to provide a unifying focus for nursing problem definition and for the best understanding the client in interaction with the environment. The client as a system may be defined as a person, family, group, community, or social issue (Neumann, 2002b, p. 15)

A system is open when its elements are continuously exchanging information and energy within its complex organization.

Stress Reaction to stress

Basic Components

The client as a system exchanges energy, information, and matter with the environment as it uses available energy resources to move toward stability and wholeness.

For the client as a system, input and output are the matter, energy, and information that are exchanged between the client and the environment.

System in the form of matter, energy, and information serves as feedback for future input for corrective action to change, enhance, or stabilize the system.

Neuman defines negentropy as . A process of energy conservation utilization that assists system progression toward stability or wellness

She likewise defines entropy as a process of energy depletion and disorganization that moves the system toward illness or possible death

Acc. to Neuman, stability is a desired state of balance in which the system copes with stressors to maintain an optimal level of health and integrity.

As defined by Neuman .. internal and external forces surrounding and affecting the client at any time comprise the environment CREATED ENVIRONMENT Is developed unconsciously by the client to express system wholeness symbolically. It purpose is to provide a safe arena for client system functioning, and to insulate the client from stressors CLIENT SYSTEM The five variables (physiological, psychological, sociocultural, developmental, and spiritual) of the client in interaction with the environment comprise the client as a system.

Basic Client Structure

The client as a system is composed of a central core surrounded by concentric rings .

Lines of Resistance
The series of broken rings surrounding the basic core structure.

Normal Line of Defense

The normal line of defense is the models outer solid circle.

Flexible Line of Defense

The models outer broken ring. It is dynamic and can be altered rapidly over a short time.

WELLNESS
Wellness exists as a stable condition when the parts of the client system interact in harmony with the whole system. System needs are met

ILLNESS
Illness occurs when the needs are not satisfied, resulting in a state of instability and energy depletion

STRESSORS
Stressors are tension-producing stimuli that have the potential to disrupt system stability. They may be : Intrapersonal forces occurring within the individual, such as conditioned responses. Interpersonal forces occurring between 1 o more individuals, such as role expectations Extrapersonal forces occurirng outside the individual, such as financial circumstances.

DEGREE OF REACTION Is the amount of energy required for the client to adjust to the stressor(s)

PREVENTION AS INTERVENTION Interventions are purposely actions to help the client retain, attain, or maintain system stability. Primary Prevention Is carried out when a stressor is suspected or identified. A reaction has not yet occurred, but the degree of risk is known. Secondary Prevention Involves interventions or treatment initiated after symptoms from stress have occurred.

Tertiary Prevention Occurs after the active treatment or secondary prevention stage. It focuses on readjustment toward optimal client system stability. RECONSTITUTION Occurs following treatment of stressor reaction. It represents return of the system to stability, which may be at a higher or lower level of wellness than prior to stressor invasion.

The person is a layered multidimensional being. Each layer consists of five person variables or subsystems:

Physical/Physiological Psychological Socio-cultural Developmental Spiritual

 an open system that works together with other parts of its body as it interact with the environment has protective mechanisms for the basic structure, and maintains clients system stability:

1. Flexible line of defense, 2. normal line of defense, and 3. lines of resistance

Environment is defined as being all the internal and external factors that surround or interact with person and client. Stressors (interpersonal, intrapersonal, and extrapersonal) are significant to the concept of environmental forces that interact with and potentially alter system stability. The internal environment exists within the client system. The external environment exists outside the client system.

 Health is equated with wellness. the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman, 1995). The client system moves toward illness and death when more energy is needed than is available. The client system moved toward wellness when more energy is available than is needed.

 a unique profession that requires holistic approach considers all factors affecting a clients health aims to promote optimal wellness to its client through retention, attainment, or maintenance of the stability of clients system nurse helps the different levels of clientele: individual, family, and groups in achieving and maintaining an optimal wellness through intervention with the goal of reducing stress factors and its adverse effects to the optimal functioning of an individual in any given situation nursing consists of intervention modalities of prevention which can be: (1.) primary, (2.) secondary, (3.) tertiary

Once an individual is exposed to stress, the flexible line of defense will be alarmed to protect the normal (solid) line of defense to keep the system free from stressor reactions. However, if this individual is continuously exposed to stress and if the flexible line of defense is unable anymore to cope up with the stressors, the normal line of defense will be altered. If this happens, there will be a threat to the wall that protects the basic structure of the individual and therefore causing instability of the systems and illness develops.

Flexible Line of Defense Normal Line of Defense

CORE CORE
STRESSORS
(Intrapersonal, Interpersonal, Extrapersonal)

Lines of Resistance

ILLNESS

Sample Situation:

Mr. Yoso is a 38 year-old business executive. His colleagues describe him as hard working, perfectionist, and very dedicated to work. His day starts by leaving the house very early from Laguna to Makati and begins work by delegating various tasks with firm expectations and deadlines that somewhat impossible to meet. He usually responds with pressure and intimidating remarks for works not perfectly done. He smokes and drinks alcohol whenever he is stressed. Recently, the company experienced continuous dropped in their sells and his bosses started to put blame to him.

continuation
Mr. Yoso began exhibiting weird mannerisms and behaviors that appear strange to his family and people around him. He misses breakfast and lunch very often and sleeps very late at night while doing work. He has no time anymore for his family and focuses to hard on meeting deadlines and his preconceived objectives. Because of these weird changes in him, the company decided to temporarily relieve him from his position as executive manager. A week later, he started to have periods of mania and depression. His family becomes worried and called up the hospital to seek assistance after he locked himself in the room, refusing to eat, and most of the time quiet and staring blankly on the wall. Later, he developed pneumonia.

Using Neumans System Model in the above situation, the identified possible stressors that contributed to Mr. Yosos condition were as follows: work, personality, and attitude. Mr. Yoso is not anymore able to handle the stressors and that had caused the breakdown of his lines of defense. Without seeking help from his family and friends, he was not able to maintain his flexible line of defense and brought instability to his system. (The diagram on the next page shows the effect of the stress in his lines of defense and the corresponding prevention that might have or may be done to prevent illness/or complications from occurring.)

Primary Prevention: Stress management activities Relaxation techniques Anger-management techniques Smoking cessation

Effects on Flexible Line of Defense: sleeps very late at night misses breakfast and lunch responds with pressure and intimidating remarks for works not perfectly done smokes and drinks alcohol whenever he is stressed

Tertiary Prevention Re-assessing patients ability to independently perform and maintain variables of health. Regular consult to psychologist. Maintaining clients support system

CORE CORE

Effects on Lines of Resistance: weakened immune response developed pneumonia

Work-related stressors

Effects on Normal Line of Defense: exhibiting weird mannerisms and behaviors periods of mania and depression

Secondary Prevention Medication (to treat symptoms) Opportunities to verbalize feelings and concerns

 Neuman sees nursing as a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor. The person is seen as a whole, and it is the task of nursing to address the whole person. Neuman defines nursing as actions which assist individuals, families and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient/client system, through nursing interventions to reduce stressors. Neuman states that, because the nurse's perception will influence the care given, then not only must the patient/client's perceptions be assessed, but so must those of the caregiver (nurse). The role of the nurse is seen in terms of degrees of reaction to stressors, and the use of primary, secondary and tertiary interventions.