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Born in 1924 on a 100-acre farm in Ohio Her father died with CKD Her mother is a rural midwife Worked as aircraft instrument repair technician, & draftsperson for an aircraft contracting company. Short order cooked in Dayton, 1947- graduated in General Hospital Medical Center 1957- received a BS in Public Health Nursing 1966-MS as a PH-mental Health Nurse Consultant from University of California 1985-granted a PhD in clinical psychology by Pacific Western University


Practiced bedside nursing as staff, head and private duty nurse School nurse and industrial nursing in community setting Office nurse in her husbands Krees private prctice in obstetrics. Counseling and crisis intervention in community mental health settings. 1967-faculty chair from which she graduated and became a teacher, author, lecturer, and consultant 1973-state mental health consultant, provided CPE and continued the development of her model

Independent Curriculum Consultant in Nursing Private Practice Health Consultant Author; Lecturer Instructor Individual & Family Counselor



1970: NSM developed as a graduate course guide to integrate four variables of man. 1972: Publication of A model for teaching total person approach to patient problems, 1974: Refined model published in Riehl & Roy, Conceptual Models for Nursing Practice. Model classified as a systems model, and titled The Betty Neuman Health-Care Systems Model: A Total Person Approach to Patient Problems. 1980: Riehl & Roy, Conceptual Models for Nursing Practice, 2nd edition. Practice tools for NSM implementation added, and term patient changed to client.

1982: Neumans first book, The Neuman Systems Model: Application to NursingEducation and Practice. Nursing process format & care plans included;Chapters include applications of the NSM to individuals, families and community;A total approach to client care. 1989: The Neuman Systems Model, 2nd ed. Created environment added to expand concept of environment. Spiritual variable added to diagram as fifth variable. 1995: The Neuman Systems Model, 3rd ed. Chapters on culture, international use of the Model, applications to administration and construction of conceptualtheoretical-structures for research added.

2002: The Neuman Systems Model, 4th ed. Co-edited by Drs. Betty Neuman and Jacqueline Fawcett. Guidelines for clinical practice, modelbased research,education and administration, plus appropriate tools highlight this edition.

2010: The Neuman Systems Model, 5th ed. Co-edited by Drs. Betty Neuman and Jacqueline Fawcett. Chapters include an expansion of the client system as an individual, family, group and community. Highlights include advances in thinking about the created environment, reconstitution, and critical thinking within the context of the NSM. Middlerange theory development and integrative theorizing conclude the edition




To achieve the maximum possible level of client system stability.



Flexible line of defence Normal line of defence Line of resistance


group, community, or social issue.

Viewed as being in constant change or motion and is seen as an open system in reciprocal interaction with the environment. (Neuman, 2002b.)



The basic structure, or central core, is made up of the basic survival factors that are common to the species (Neuman, 1995, in George, 1996). These factors include: system variables, genetic features, the strengths and weaknesses of the organs and system parts, ego structure and value system


A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance.


Outer boundary The flexible line of defense acts as a cushion and is described as accordion-like as it expands away from or contracts closer to the normal line of defense If the flexible line of defense fails to provide adequate protection to the normal line of defense, the lines of resistance become activated

Flexible line of defence

The normal line of defense represents system stability over time.

Normal Line of Defense



normal line of defense can change over time in response to coping or responding to the environment.


The last boundary protest structure The lines of resistance protect the basic structure and become activated when environmental stressors invade the normal line of defense. If effective the system can reconstitute and if the line of resistance are not effective, the resulting energy loss can result to death

Line of resistance

Reconstitution begins at any point following initiation of treatment for invasion of stressors. Reconstitution may expand the normal line of defense beyond its previous level, stabilize the system at a lower level, or return it to the level that existed before the illness. It depends on successful mobilization of client resources to prevent further reaction to stressor, and it represent the dynamic state of adjustment.


Considers her work a wellness model


Neuman sees health as being equated with wellness. She defines health/wellness as "the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman, 1995)". As the person is in a constant interaction with the environment, the state of wellness (and by implication any other state) is in dynamic equilibrium, rather than in any kind of steady state.

Neuman proposes a wellness-illness continuum, with the person's position on that continuum being influenced by their interaction with the variables and the stressors they encounter. The client system moves toward illness and death when more energy is needed than is available. The client system moves toward wellness when more energy is available than is needed




Internal environment interaction contained with in the client. External environment- between individuals, occuring outside the client. Created environment- created and developed unconsciously by the client and is symbolic of system wholeness. The intrapersonal, interpersonal and extra personal stressors which can affect the person's normal line of defense and so can affect the stability of the system int erp ers on al int ra per so nal ext ra per so nal



Primary Prevention/ intervention SecondaryPrevention/intervention Tertiary prevention/intervention

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. 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. The role of the nurse is seen in terms of degrees of reaction to stressors, and the use of primary, secondary and tertiary interventions



occurs before the system reacts to a stressor it strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors, and on the other hand manipulates the environment to reduce or weaken stressors. Primary prevention includes health promotion and maintenance of wellness.



occurs after the system reacts to a stressor and is provided in terms of existing systems. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor. Treatment of signs and symptoms,




after the system has been treated through secondary prevention strategies. support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution. back to primary prevention




Envisons of nursing process


Although each individual client or group as a client system is unique, each system is a composite of common known factors or innate characteristics within a normal, given range of response contained within a basic structure y Many known, Unknown and universal Environmental Stressors exist. Each differs in its potential for disturbing a clients usual stability level, or normal line of defence. y Each individual client has evolved a normal range of response to the environment that is referred to as a normal line of defense, usual stability state.

When the cushioning effect of the flexible line of defense is no longer capable of protecting the client system against an environmental stressor, the stressor breaks through the normal line of defense. The interrelationships between variables determine the nature of degree of the system reaction or possible reaction to the stressor. y The client, whether in a state of wellness or illness, is a dynamic composite of interrelationships between variables, wellness is a continuum of available energy to support the system in an optimal state of system stability. y Implicit within each client system is a set of internal resistance factors known as line of resistance, which function to stabilize and return the client to the usual state of wellness or possibly to a higher level of stability following an environmental stressor reaction.

Primary prevention relates to general knowledge that is applied to client assessment and intervention in identification and reduction or mitigation of possible or actual risk factors associated with the environmental stressors to prevent possible reaction. y Secondary prevention relates to symptomatology following a reaction to stressors, appropriate ranking of intervention priorities, and treatment to reduce their noxious effects. y Tertiary prevention relates to the adjustive processes taking place as reconstitution begins and maintenance factors move the client back to the circular manner toward primary prevention y The client as a system is in dynamic, constant energy exchange with the environment.

3-STAGE NURSING PROCESS Nursing Diagnosis Based of necessity in a thorough assessment, and with consideration given to five variables in three stressor areas.

These must be negotiated with the patient, and take account of patient's and nurse's perceptions of variance from wellness

NURSING OUTCOMES Considered in relation to five variables, and achieved through primary, secondary and tertiary interventions


Using system model in the assessment phase of nursing process the nurse focuses on obtaining a comprehensive client data base to determine the existing state of wellness and actual or potential reaction to environmental stressors.

The synthesis of data with theory also provides the basis for nursing diagnosis. The nursing diagnostic statement should reflect the entire client condition.


It involves negotiation between the care giver and the client or recipient of care. The overall goal of the care giver is to guide the client to conserve energy and to use energy as a force to move beyond the present.

Nursing action are based on the synthesis of a comprehensive data base about the client and the theory that are appropriate to the clients and caregivers perception and possibilities for functional competence in the environment.

the anticipated or prescribed change has occurred. If it is not met the goals are reformed.

Mr. Lungs is a 48 y/o, male, married, Catholic, resides in Bacarra, I.N and A sales manager with a smoking habit for 10 years. And is financialy stable He manifests (+)inspiratory crackles,Productive cough, dyspnea, fever ,expiratory grunt, and tachypnea causing him to seek medical care at MMMH and MC and was diagnosed of having pneumonia. He is Psychologically disturbed about his disease condition- anticipating it as life threatening. He experienced similar problem 1 month ago . He took OTC Drugs Like Tuseran, Rubitussin. He used to divert his attentions when suffering form DOB by sitting and to relax by watching tv. Client perceived that the present disease condition is much more severe than the previous condition. He thinks it is a serious form of resp. d/o. Now, he anticipates that he can not return back to smoking anymore. He lives with his family and has a good interrelationships with each other and also to his friends. He is used to read religious materials and goes to church with his family every Sunday. He seeks medical care with his family for his faster treatment and recovery of his dse. And he and his family is willing to cooperate for treatments.

Patient profile Name: Mr. Lungs Age:48 y/o Sex: Male Marital Status: Married

Referral Source and Related information: MMMH and MC



(+)inspiratory crackles,Productive cough, dyspnea, fever ,expiratory grunt, tachypnea. Psychologically disturbed about his disease conditionanticipating it as a life threatening condition. Smoking habit for 10 years, active in church, cares for his family, reading rel, books and watching tv. Taking OTC Drugs Like Tuseran, Rubitussin. Divert attention from DOB by sitting and watching tv.

(+)inspiratory crackles,Productive cough, dyspnea, fever ,expiratory grunt, tachypnea. anticipatory anxiety concerns the recovery and prognosis of the disease, Psychologically disturbed. (lifestyle pattern)

Client perceived that the present disease condition is much more severe than the previous condition. He thinks it is a serious form of resp. So patient is psychologically depressed.



Anticipate that there will be a change in his lifestyle habit, and to recover from his dse.
He expects to help him in the treatment of his condition and will give his full cooperation regarding for the treatment of the dse. Family members will help him to meet his own personal needs as much as possible. Involve him in taking decisions about his own care, treatment, follow up with the HC team for speedy recovery.

Patient is using his own coping strategies to adjust to the situations. He is spending time to read religious books and also knows how to relax himself. Client is capable of handling the situation- will need support and encouragement to do so.

(anticipation) He is wiling to cooperate in the treatment of his dse. He expects that Family members will help him to meet his own personal needs as much as possible.

Client Nurse/Caregiver

Involve him in taking decisions about his own care, treatment, follow up with the HC team for speedy recovery.

Evaluation/ summary of impressions


is no apparent discrepancies identified between patients perception and the care givers perceptions

Intrapersonal factors
Physiological- (+)inspiratory crackles,Productive cough, dyspnea, fever ,expiratory grunt, tachypnea Diagnosed to have pneumonia. Psycho socio cultural factors- patient is anxious abut his condition. Disturbed mood.Good support system is present. Smoking habit for 10 years Developmental no developmental abnormalities. Appropriate to the age.Sucessful in his carreer as a sales manager. Spiritual- patients belief system has a positive contribution to his recovery and adjustment. Reading religious material, sometimes he goes to church with his family

Interpersonal Factors- he lives with his familyhas supportive

family and friends, good social support system is present, Good interpersonal relationship with wife and the children

Extrapersonal Factors-All the health care facilities are present

at his place, Financially they are stable and are able to meet the treatment expenses.


Impaired gas exchange related to altered oxygen supply and alveolar-capillary membrane changes secondary to inflammatory process in the lungs


Primary Prevention

Secondary Prevention I. Treatment of the signs and symptoms 1. Medications 2. Placing on fowlers position 3. Physiotherapy 4. Deliberation of oxygen inhalation II. Involve the patient in making decisions about his own care and provide a positive psychological support with his family. III. Health teachings: 1. Avoid strenuous activities

Tertiary Prevention

1. Asses pain severity 2. Smoking cessation 3. Clean environment and ventilation 4. Stress management 5. Relaxation techniques 6. Adequate nutrition and sleep

Re assesing patients ability to independently perform and maintain variables of health: 1. Proper lifestyle habbit 2. Proper nutrition 3. Adequate rest Health teachings: 1. Emphasizing d/a of smoking 2. Proper disposal of secretions. Involve the family members in the care of patient



The Neumans system model when applied in nursing practice is a big help in identifying the interpersonal, intrapersonal and extra personal stressors of Mr. Lungs from various aspects. This was helpful to provide care in a comprehensive manner. The application of this theory revealed how well the primary, secondary and tertiary prevention interventions could be used for solving the problems in the client.

Only in this life you can do Good What awaits you in the next life is not the opportunity to do Better, But to enjoy the reward for having done Best


April Joyce Rosete Ines BSN, RN, future MAN.