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292 UNIT III Nursing Conceptual Models

of preventive interventions, which are all important This model has been well accepted by the nursing
to delivery of care. The focus on primary prevention community and is used in administration, practice,
and interdisciplinary care is futuristic and serves education, and research. The Neuman Systems Model
to improve quality of care. The Neuman nursing pro- Trustees Group is actively involved in protecting the
cess fulfills current health mandates by involving the integrity of the model and advancing its development.
client actively in negotiating the goals of nursing care The Neuman Systems Model Research Institute has
(Neuman, 2011b). been established and is working to generate and test
A major feature of the model is its potential middle-range theories based on the model.
to generate nursing theory, for example, the theories
of optimal client stability and prevention as interven- CASE STUDY
tion (Fawcett, 1995a). The model concepts are highly
relevant for use by health professionals in the twenty- Individuals and a Family as a Client
first century. Through continued theory development Elizabeth Jefferies is a divorced 46-year-old mother
and research with the model, the nursing discipline of two children and the daughter of two aging
can expand its scientific knowledge base. According parents in the southeastern United States. She and
to Fawcett (1989, 1995b), the model meets social con- her children have recently relocated from an urban
siderations of congruence, significance, and utility. neighborhood to a rural town to care for her parents,
The model is broad and systems based. It lends itself Robert and Susan. The move involved a job change
well to a comprehensive approach for nurses to evalu- for Elizabeth, a change in schools for the children,
ate evidence and respond to the world’s rapidly chang- and an increased distance from the children’s father.
ing health care needs.
Robert is a 72-year-old Methodist minister who
recently suffered a stroke, leaving him with dimin-
SUMMARY ished motor function on his left side and difficulty
The Neuman Systems Model is derived from general swallowing. Susan is 68 years old and suffers from
fibromyalgia, limiting her ability to assist with the
system theory. Its focus is on the client as a system daily care of her husband. She has experienced an
(which may be an individual, family, group, or com- increase in generalized pain, difficulty sleeping, and
munity) and on the client’s responses to stressors. The worsening fatigue since her husband’s stroke.
client system includes five variables (physiological, Use the Neuman Systems Model as a conceptual
psychological, sociocultural, developmental, and framework to respond to the following:
spiritual) and is conceptualized as an inner core n Describe the Jefferies family as a client system
(basic energy resources) surrounded by concentric using each of the five variables.
circles that include lines of resistance, a normal line of n What are the actual and potential stressors that
defense, and a flexible line of defense. Each of the five threaten the family? Which of these stressors are
variables is considered in each of the concentric positive, and which are negative? What actual
circles. Stressors are tension-producing stimuli that and potential stressors threaten the individual
may be intrapersonal, interpersonal, or extrapersonal members of the family? Which of these stressors
in nature. are positive, and which are negative?
The model proposes three levels of nursing inter- n What additional nursing assessment data are
vention (primary prevention, secondary prevention, needed considering Robert’s medical diagnoses?
tertiary prevention) based on Caplan’s concept of lev- What additional data would be helpful for
els of prevention (1964). The purpose of prevention as Susan’s medical diagnoses?
intervention is to achieve the maximum possible level n What levels of prevention intervention(s) are
of client system stability. Neuman suggests a nursing appropriate for the Jefferies family? What levels
process format in which the client, as a recipient of of prevention intervention(s) are appropriate
care, participates actively with the nurse as caregiver for each individual member of the family?
to set goals and select interventions.