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282 UNIT III Nursing Conceptual Models

(Neuman, Deloughery, & Gebbie, 1971). Neuman de- within the organism. When the stabilizing process fails
signed a nursing conceptual model for students at to some degree, or when the organism remains in a state
UCLA in 1970 to expand their understanding of client of disharmony for too long, illness may develop. If the
variables beyond the medical model (Neuman & Young, organism is unable to compensate through illness, death
1972). Neuman first published her model during the may result (Neuman & Young, 1972).
early 1970s (Neuman & Young, 1972; Neuman, 1974). The model is also derived from the philosophical
The first edition of The Neuman Systems Model: Applica- views of de Chardin and Marx (Neuman, 1982). Marxist
tion to Nursing Education and Practice was published in philosophy suggests that the properties of parts are
1982; further development and revisions of the model determined partly by the larger wholes within dynami-
are illustrated in subsequent editions (Neuman, 1989, cally organized systems. With this view, Neuman (1982)
1995, 2002b, 2011b). confirms that the patterns of the whole influence aware-
Since developing the Neuman Systems Model, ness of the part, which is drawn from de Chardin’s
Neuman has been involved in numerous publications, philosophy of the wholeness of life.
paper presentations, consultations, lectures, and confer- Neuman used Selye’s definition of stress, which is
ences on application and use of the model. She is a the nonspecific response of the body to any demand
Fellow of the American Association of Marriage and made on it. Stress increases the demand for readjust-
Family Therapy and of the American Academy of Nurs- ment. This demand is nonspecific; it requires adapta-
ing. She taught nurse continuing education at UCLA tion to a problem, irrespective of the nature of the
and in community agencies for 14 years and was in problem. Therefore, the essence of stress is the non-
private practice as a licensed clinical marriage and fam- specific demand for activity (Selye, 1974). Stressors
ily therapist, with an emphasis on pastoral counseling. are the tension-producing stimuli that result in stress;
Although retired, Neuman continues to do occasional they may be positive or negative.
pastoral and nutritional counseling. Neuman lives in Neuman adapts the concept of levels of prevention
Ohio and maintains a leadership role in the Neuman from Caplan’s conceptual model (1964) and relates
Systems Model Trustees Group. She serves as a consul- these prevention levels to nursing. Primary preven-
tant nationally and internationally regarding imple- tion is used to protect the organism before it encoun-
mentation of the model for nursing education programs ters a harmful stressor. Primary prevention involves
and for clinical practice agencies. reducing the possibility of encountering the stressor
or strengthening the client’s normal line of defense to
decrease the reaction to the stressor. Secondary and
Theoretical Sources tertiary prevention are used after the client’s encoun-
The Neuman Systems Model is based on general sys- ter with a harmful stressor. Secondary prevention
tem theory and reflects the nature of living organisms attempts to reduce the effect or possible effect of
as open systems (Bertalanffy, 1968) in interaction stressors through early diagnosis and effective treat-
with each other and with the environment (Neuman, ment of illness symptoms; Neuman describes this as
1982). Within this model, Neuman synthesizes strengthening the internal lines of resistance. Tertiary
knowledge from several disciplines and incorporates prevention attempts to reduce the residual stressor
her own philosophical beliefs and clinical nursing effects and return the client to wellness after treat-
expertise, particularly in mental health nursing. ment (Capers, 1996; Neuman, 2002b).
The model draws from Gestalt theory (Perls, 1973),
which describes homeostasis as the process by which an
organism maintains its equilibrium, and consequently Use of Empirical Evidence
its health, under varying conditions. Neuman describes Neuman conceptualized the model from sound theo-
adjustment as the process by which the organism satis- ries before nursing research was begun on the model.
fies its needs. Many needs exist, and each may disrupt She initially evaluated the utility of the model by sub-
client balance or stability; therefore, the adjustment mitting a tool to her graduate nursing students at UCLA
process is dynamic and continuous. All life is character- and published the outcome data in Nursing Research
ized by this ongoing interplay of balance and imbalance (Neuman & Young, 1972). Subsequent nursing research