BETTY NEUMAN

A System Model Study Using an EvidenceBased Theory

THEORY

Based on a wholistic approach to patient

care.
Views the client as an open system.
includes :
patient
family
community
society
Proposes that nurses enter into the clients
world to promote stability and balance .
Neuman & Fawcett, 2002

CIRCLES WITHIN THE NEUMAN

SYSTEM MODEL
The Neuman model is illustrated by multiple
circles which demonstrate the patients line
of defense.
Lines of Resistance: LOR
Flexible Lines of Defense: FLD
Normal Line of Defense: NLD

These structures of Neumans system model

will be referred to throughout the case
study which will be presented.

Variables of Stressors
A clients stability and balance can be affected by
stress. Stressors disrupt client systems, sometimes
causing physical illness or emotional and social
crises (Ume-Nwagbo,DeWan, and Lowry, 2006).
The Neuman Model assesses the client with different
variables of stressors.
Five variables of stressors are:

Physiological
Psychological
Sociocultural
Developmental
Spiritual

Case Example of an Individual Client

With a Physiological Stressor
The client is a 60 year old man
He is scheduled for a CABG in 1 week
History of mild COPD, d/t 20 year history of
smoking
Overall a good candidate for surgery, based
on the cardiothoracic surgeons
Primary stressor is Physiological due to
mechanical ventilation

NURSE AND CLIENT ROLES

It is the responsibility of the nurse to assist
the client in identifying potential stressors
in a health related issue.
Once the stressor is identified, the nurse will
assess the stressor reaction in all five
variables, as well as the perception of the
client.
Once identified, the nurse and client will
negotiate goals and formulate strategies to
meet the goals.(Neuman & Fawcett, 2002).

PATIENT ASSESSMENT
The protective abilities of the NLD were evaluated:
blood count with differential, chemistry profile, liver enzymes
chest x-ray,
urinalysis,
clotting studies
medication assessment

The FLD in relation to the physiological assessment:

intact intrapleural space
skin integrity
perfusion capabilities
contractility of the heart
glomerular function
peripheral perfusion

PATIENT ASSESSMENT
(CONT.)
The Line of Resistance:
protects the basic structure energy resources
provide internal protection factors when stressors
have penetrated the NLD
In this study, the LOR is evaluated by:
preoperative lab values
skin integrity,
cardiac function
pulmonary function
sympathetic and parasympathetic systems

PSYCHOLOGICAL
VARIABLES
Once the physiological variables are assessed,
the psychological variables are determined:
1. Psychological health of the patient; ego
strength.
2. Patients values, and ability to react to
stressors
3. Patients past experience with surgical
procedures
4. Coping mechanisms
5. Perception of wellness

VARIABLES (CONT.)
The developmental variable
age-related developmental skills
ability to function as a dependent person
perceive appropriate pain management
The sociocultural variables
financial resources
cultural/ethnic
personal financial obligations.
The spiritual assessment
spiritual practices
spiritual values

CASE SUMMARY
The main stressor in this case is the surgical
procedure and the postoperative
mechanical ventilation.
CABG is a major physiological stressor
If uncomplicated the stressor will benefit
the patient by preventing further disease
Nursing diagnosis was met by the patients
ability to overcome the stress of CABG

INTERVENTIONS
Primary
Diet
Medication
Secondary
Secondary
Immediate post-op care
System stability
Tertiary (1 week to 6 months post-op)
Rehabilitative period
Wellness assessment

EVALUATION
The evaluation will determine if goals were
met.
In this particular case the patients goals were
met.
Periodic evaluation will be done to evaluate for
stressors that can affect his health.
Assess for healthy lifestyle
The Neuman system model provides a
theoretical framework for assessing, planning,
evaluating and providing evidence-based
outcomes.

CONCLUSION
Credibility:
1. Comprehensive
2. Flexible
3. Client focused
4. Wholistic
5. Individualized
Because the system is theory based, it ensures integrity
of care.
Limitations:
Neuman focuses on client stressors rather than
medical diagnoses, which may have the potential to
leave nursing expertise behind(Ume-Nwagbo, 2006).

BIBLIOGRAPHY

Neuman, B., & Fawcett, J. (2002). The Neuman

systems model (4th ed.). Upper Saddle River,
NJ:
Prentice Hall.
Ume-Nwagbo, P. N., DeWan, S. A., & Lowry, Lois W.
(2006). Using the Neuman Systems Model for Best
Practices. Nursing Science Quarterly , 19 (1),
31- 35.