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Applying the Neuman’s Model to manage cardiac issues.

Mariah K. Hart, RN

School of Nursing: Old Dominion University

NURS 306: Theortical Foundations of Professional Nursing Practice

Dr. Craig Cunningham

November 19, 2021

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Applying the Neuman’s System Model to manage cardiac issues.

The Neuman’s system model takes a holistic approach to identify factors that affect the

health and well being of an individual or group (Alligood & Lawson, 2018, Chapter 16). The

Neuman model is designed as a spherical shape with the core of the design representing the

individual or group being studied (Alligood & Lawson, 2018, Chapter 16). Emanating from the

core are three protective rings studied (Alligood & Lawson, 2018, Chapter 16). The furthest ring

from the core is the flexible line of defense (FLD), which serves as the first level of protection

for the core studied (Alligood & Lawson, 2018, Chapter 16). The FLD’s primary function is to

act as a barrier to block stressors from disrupting the health of the individual studied (Alligood &

Lawson, 2018, Chapter 16). The second inner level is the normal line of defense, which serves

to preserve the equilibrium of the core studied (Alligood & Lawson, 2018, Chapter 16). The third

level is the lines of resistance and is subsequently the last level of protection closet to the core

studied (Alligood & Lawson, 2018, Chapter 16). If an outside stressor surpasses this level it has

reached the core studied (Alligood & Lawson, 2018, Chapter 16). Neuman defines stressors as

external organisms that interfere with the balance of the core studied (Alligood & Lawson, 2018,

Chapter 16). The Neuman’s system model postulates that stressors can interact positively or

negatively to a client’s health studied (Alligood & Lawson, 2018, Chapter 16). Neuman states

that there are three supportive systems referred to as: primary, secondary, and tertiary that

support the success of the health intervention studied (Alligood & Lawson, 2018, Chapter 16).

The benefit of utilizing the Neuman’s system model is that it appreciates all the contributing

entities that may impact the person or group studied (Alligood & Lawson, 2018, Chapter 16).

The entities that impact the client include environmental, cultural, and physiological stressors

studied (Alligood & Lawson, 2018, Chapter 16). The limitation of the theory is the potential
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dishonesty of the client by hiding a lifestyle choice that could severely impact the plan of care

(Alligood & Lawson, 2018, Chapter 16).

The purpose of this paper is to review Neuman’s system model and evaluate how it’s

components could be applied to care for postpartum women with hypertensive disorders.

Applying Neuman’s Model to manage cardiac health problems in Filipino Americans.

In the article: “Care Delivery for Filipino Americans Using the Neuman Systems Model,”

the authors believe using the principles and tools of Neuman’s model, nurses and healthcare

workers could effectively treat and manage coronary heart disease in this cultural group

(Angosta et al., 2014). The authors suggest by utilizing Neuman’s system model, nurses would

be capable of identifying cultural stressors in Filipino Americans who seem to be predisposed to

cardiac health disease (Angosta et al., 2014). Some contributing factors that were identified in

the article as stressors to Filipino Americans included: the propensity to retain abdominal fat,

higher rates of smoking cigarettes and alcohol consumption, limited exercise, and stressful

family dynamics (Angosta et al., 2014). Additionally, the Neuman’s model describes three

preventive components, which are the primary, secondary, and tertiary interventions Alligood &

Lawson, 2018, Chapter 16). Under Neuman’s model the primary level of prevention is where the

initial assessment occurs Alligood & Lawson, 2018, Chapter 16). During the primary prevention

phase, the nurse must identify all contributing known health risks, coping abilities, interpersonal

relationships, and access to resources that are available to the client (Alligood & Lawson, 2018,

Chapter 16). In the case of Filipino Americans, the authors suggested that this group would

benefit from cardiac disease education, health screenings, and forming an exercise regiment

(Angosta et al., 2014). Neuman’s secondary level of prevention treats the developed symptoms

from a disease and strives to deter worsening progression (Alligood & Lawson, 2018, Chapter
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16). Treatment for coronary heart disease in this scenario includes the patient taking

antihypertensive medication, starting a smoking cessation program, monitoring lab values, and

attending more frequent doctor appointments (Angosta et al., 2014). The final level of Neuman’s

model is the tertiary level of prevention, which is the maintenance tier (Alligood & Lawson,

2018, Chapter 16). Once the patient has reached a satisfactory level of wellness, the authors

suggest wellness is maintained by routine follow up appointments and continued evaluation of

the client’s support system (Angosta et al., 2014). Overall, the authors provided a thorough

analysis of the cardiac health issues that plague Filipino Americans. The authors presented a

multiplicity of examples of how the Neuman model when applied to this group could identify

stressors, provide education and treatment, and evaluate effectiveness of the treatment regiment

among the Filipino American community (Angosta et al., 2014). However, the authors were

transparent that so far no recognized health care system has used the Neuman model to treat the

Filipino American community and their cardiac health risks (Angosta et al., 2014).

Utilizing Neuman’s model to manage hypertension in a high-risk maternity population.

I currently work as a postpartum nurse on a high-risk obstetrics unit. One of the major

clinical practice issues that we manage on my unit is hypertensive disorder in the postpartum

period. Effective management of hypertension requires diligent assessments, monitoring, and

evaluating the effectiveness of the medication regiment. Hypertension is an established cause of

maternal morbidity; moreover, women of color are disproportionately affected (American

College of Obstetricians and Gynecologists 2019 as cited in Wisner, 2019). Under Neumans’s

model, primary intervention would include gathering an initial data about the patient and her

family health history, evaluating current workplace or home life stressors, and providing a brief

overview of the difference between gestational hypertension and preeclampsia. At my

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workplace, if her pressure were to remain elevated and require more intense monitoring she

would be admitted to triage in labor and delivery and started on magnesium sulfate, placing the

patient in Neuman’s secondary level of intervention. Once she has delivered and I have assumed

care, her vital signs are monitored every four hours until the time of discharge. If the patient’s

blood pressures remain elevated and the providers determine she needs another dose of

magnesium sulfate, a labor and delivery nurse must initiate the bolus dose and then once the dose

has been ordered as maintenance I am able to manage the medication. After the magnesium

sulfate infusion has been completed and the providers have trended and reviewed labs and vitals,

the patient is closely monitored for rebound hypertension. If the patient presents with a severe

range pressure, our providers manage it first with Procardia XL by mouth and if the pressures

continue to rise, we administer Labetalol IV. Once the patient’s discharge order has been placed,

on her after visit summary paperwork, the providers will request to see her at the EVMS clinic

for a one-week blood pressure check. Sentara Norfolk General Hospital has patterned with

Children’s Health Investment Program (CHIP) to designate a nurse to follow a mom who has

postpartum hypertension with home visits for one year (Gauding, 2021). This holistic approach

satisfies the Neuman’s model tertiary prevention because the patient is receiving continued

education and community support to manage hypertension.

Conclusion

In conclusion, Neuman’s system model provides a complete picture of the factors that are

affecting the patient’s health dynamics. Neuman’s model allows the nurse to evaluate the factors

that led the patient to their current state of health. Additionally, Neuman’s model allows the

treatment regiment to be evaluated and adjusted to see what is working or what is not effective

for the patient. Neuman’s model also allows the patient to contribute tangible data for the
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provider to evaluate the effectives of the recommended treatment (Alligood & Lawson, 2018,

Chapter 16).

In my personal opinion, I often wonder how my patient’s are doing long after they are

discharged. It provides me great peace when I consent a patient to the Mom’s Matter program

because I know the patient will have professional support once they leave the hospital doors.

Neuman’s system model provides a great template of theory because although I operate in the

secondary level of intervention, I can easily evaluate the primary level of intervention by open

dialogue with the patient, providers and reviewing the H&P. I learned from this assignment that I

carry out principles of Neuman’s theory every shift.

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Honor Code

I pledge to support the Honor System of Old Dominion University. I will refrain from

any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as

a member of the academic community it is my responsibility to turn in all suspected violations of

the Honor Code. I will report to a hearing if summoned.

Signed: Mariah Hart

Date: 11/19/2021
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References

Angosta, A., Ceria-Ulep, C., & Tse, A. (2014). Care Delivery for Filipino Americans Using the

Neuman Systems Model. Nursing Science Quarterly, 27(2), 142-148.

Alligood, M.R. & Lawson, T.G (2018). Systems Model. In Nursing theorists and their work,

essay, Elsevier.

Gauding, D. (2021, March 5). Sentara Moms Matter initiative supports new Moms with

hypertension. Sentara. Retrieved November 15, 2021, from

https://www.sentara.com/hampton-roads-virginia/aboutus/news/news-articles/sentara-

moms-matter-initiative-supports-new-moms-with-hypertension.aspx

Wisner, K. (2019). Gestational hypertension and preeclampsia. MCN: The American Journal of

Maternal/Child Nursing, 44(3), 170.

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