Page 347 - Encyclopedia of Nursing Research

314 n NeuROBeHAvIORAL DeveLOPMeNT

wellness. Primary components of the NSM system (CNS) achieves maturity in form and
include stressors, lines of defense and resis- function. Neurodevelopment also depends
N tance, levels of prevention, the five client on the environment since CNS development
systems variables (basic structure, interven- occurs through an “experience expectant”
tions, internal and external environment, process in which normal species-typical
and reconstitution; Neuman, 2001). The experiences enable the CNS to make the
nurse is an intervener who uses three lev- structural and functional changes neces-
els of prevention (primary, secondary, and sary for the next stages of development
tertiary) to achieve the goal of reducing the (Greenough, Black, & Wallace, 1987). In order
client’s encounter with stressors and mitigat- to balance the needs of the present develop-
ing the impact of the stressor. The client or mental stage and the anticipated needs of
client system may be an individual, group, subsequent stages, this process is somewhat
family, and community and is composed plastic (Oppenheim, 1981). When an infant is
of five interrelated variables (physiological, placed in an atypical environment, such as
psychological, sociocultural, developmental, a neonatal intensive care unit, ontogenetic
and spiritual). Health, according to Neuman adaptation is affected. Although the infant
(2001), is equated with living energy, deter- may initially adapt successfully, changes in
mined by the degree of harmony among the trajectory of the infant’s neurobehavioral
the five client variables and basic structure developmental may be maladaptive at older
factors, on a continuum from wellness to ages. The effects of this disturbance vary
illness. The degree of wellness is deter- depending on the timing and severity of
mined by the amount of energy required environmental stresses, individual genetic
to retain, attain, or maintain system stabil- background, the interaction of genetic back-
ity (Neuman, 2001, p. 12). An integrative ground and prenatal history, adaptations
review of NSM-based research conducted made to uterine stresses, and specific neu-
by Fawcett and Giangrande (2001) found 200 rological insults. Infants probably develop
research reports with an analysis focused normally when neural plasticity—the pro-
on general information, scientific merit, cess by which the brain develops new con-
and the NSM. Gigliotti and Fawcett (2001) nections after neural damage—compensates
reviewed 212 research reports and identified for abnormalities due to any atypical onto-
different instruments explicitly linked to the genetic adaptation and neurological insults.
NSM—sometimes more than once and for Infants exhibit abnormal neurobehavioral
different purposes. To enhance and facilitate development when neural plasticity is not
future research related to the NSM, Neuman able to compensate or when compensatory
and Fawcett (2001) have established a set of processes result in structural or functional
guidelines for NSM-based research. changes that are maladaptive at later ages.
The Synactive Model of Neonatal
Patricia Hinton Walker Behavioral Organization provides a frame-
work for exploring the concept of neurobe-
havioral development. Als (1986) and Als,
Neurobehavioral Duffy, and McAnulty (1996) have proposed
a dynamic model for assessing infant behav-
developmeNt ioral organization. They suggested that the
behavioral organization displayed by an
infant is a reflection of the infant’s central
Neurobehavioral development may be nervous system integrity, defined as the
viewed as a genetically determined pro- potential for the brain to develop normally.
cess by which the primitive central nervous The infants’ behaviors reflect subsystems of