Theoretical Foundations in Nursing: Betty Neuman

Systems Model

"Health is a condition in which all parts and subparts are in harmony

with the whole of the client.”

Viewed the client as an open system consisting of a basic structure or central core of energy resources which represent concentric circles
Each concentric circle or layer is made up of the five variable areas which are considered and occur simultaneously in each client concentric circles. These are:

Physiological - refers of bodily structure and function.
Psychological - refers to mental processes, functioning and emotions.
Sociocultural - refers to relationships; and social/cultural functions and activities.
Spiritual - refers to the influence of spiritual beliefs.
Developmental - refers to life’s developmental processes.

This is otherwise known as the central core, which is made up of the basic survival factors common to all organisms. These include the following:

The person's system is an open system - dynamic and constantly changing and evolving
Stability, or homeostasis, occurs when the amount of energy that is available exceeds that being used by the system.
A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance

Is the outer boundary to the normal line of defense, the line of resistance, and the core structure.
Keeps the system free from stressors and is dependent on the amount of sleep, nutritional status, as well as the quality and quantity of stress an individual experiences.
If the flexible line of defense fails to provide adequate protection to the normal line of defense, the lines of resistance become activated.

Represents client’s usual wellness level.
Can change over time in response to coping or responding to the environment, which includes intelligence, attitudes, problem solving and coping abilities. Example is skin which is constantly smooth and fair will eventually form callous over times.

the last boundary that protects the basic structure
Protect the basic structure and become activated when environmental stressors invade the normal line of defense. An example would is that when a certain bacteria enters our system, there is an increase in leukocyte count to combat infection.
If the lines of resistance are effective, the system can reconstitute and if the lines of resistance are not effective, the resulting energy loss can result in death.

Are capable of producing either a positive or negative effect on the client system.
Is any environmental force which can potentially affect the stability of the system:

Intrapersonal - occur within person, example is infection, thoughts and feelings
Interpersonal - occur between individuals, e.g. role expectations
Extrapersonal - occur outside the individual, e.g. job or finance concerns

A person’s reaction to stressors depends on the strength of the lines of defense.
When the lines of defense fails, the resulting reaction depends on the strength of the lines of resistance.
As part of the reaction, a person’s system can adapt to a stressor, an effect known as reconstitution.

Is the increase in energy that occurs in relation to the degree of reaction to the stressor which starts after initiation of treatment for invasion of stressors.
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.
Nursing interventions focus on retaining or maintaining system stability.
By means of primary, secondary and tertiary interventions, the person (or the nurse) attempts to restore or maintain the stability of the system.

Is the primary nursing intervention.
Focuses on keeping stressors and the stress response from having a detrimental effect on the body.

Primary prevention focuses on protecting the normal line of defense and strengthening the flexible line of defense. This occur before the system reacts to a stressor and strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors and also manipulates the environment to reduce or weaken stressors. Includes health promotion and maintenance of wellness.
Secondary prevention focuses on strengthening internal lines of resistance, reducing the reaction of the stressor and increasing resistance factors in order to prevent damage to the central core. This occurs after the system reacts to a stressor. This includes appropriate treatment of symptoms to attain optimal client system stability and energy conservation.
Tertiary prevention focuses on readaptation and stability, and protects reconstitution or return to wellness after treatment. This occurs after the system has been treated through secondary prevention strategies. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.