Overview of Neuman Systems Model

The aim of the Neuman model is to set forth a structure that depicts the
parts and subparts and their interrelationship for the whole of the client as a
complete system (Neuman, 2011, p. 12). As depicted in Figure 11-1, and beginning
from the center of the figure, the Neuman model identifies a basic structure of
energy resources, variables, system boundaries, and the environment as the core
subparts of the system.
At the core of the diagram, energy resources are noted. A constant energy
exchange occurs between the client system and environment. The client maintains
and augments system stability by using energy, regarded as a positive force
available to the system. As such, stability is not static but adaptive and
developmental in nature because the client system is considered an open system in
a state of constant change.
A series of protective rings encircle the center structure and protect the
system from environmental stressors. Each system component is intersected by five
variables (physiological, psychological, sociocultural, developmental, and spiritual).
These five variables interact synergistically and wholistically within all parts of the
client system (Neuman, 2011). As noted, Neuman considers client to be an
individual, a group, a family, or a community system. Accordingly, the substance of
each of the five variables depends on which client system is being considered. For
example, the physiological variable is defined as body structure and internal
function (Neuman, 2011, p. 16). Therefore, circulation could be considered a
physiological variable for an individual. Objective data that reflect the physiological
variable of circulation would include vital signs, peripheral pulses, and heart sounds.
However, for a community system, the physiological variable could include vital
statistics, morbidity, mortality, and general environmental health (Hassell, 1998,
Jajic, et al., 2011). Psychological variables include mental processes and interactive
environmental effects (Neuman, 2011, p. 16). For example, self-esteem and its
effect on relationships for the individual and communication patterns for a family
could be considered components of the psychological variable. The developmental
variable refers to life developmental processes and/or developmental tasks that
relate to life changes (e.g., individual adjustment to aging parents or empty nest
syndrome for a couple). The combination of social and cultural functions or
influences defines the sociocultural variable. Both ethnic cultural practices and
health belief practices are examples and important components of this variable
regardless of how the client system is defined. Client belief influence is exhibited in
the spiritual variable. As an example, spiritual factors could include a persons
worldview and perceived sources of strength or hope, or the predominant religious
culture of a community system (Hassell, 1998). Neuman proposes each of these five
variables as system subparts that are open, with energy exchange existing within

and between the client system and the environment (Neuman, 2011). As noted in
Figure 11-1, these five variables are considered simultaneous influences on the
system.
At the center of the diagram is the clients basic structure composed of
energy resources that Neuman calls survival factors (Neuman, 2011, p. 16).
Within the basic core, the five interacting variables (physiological, psychological,
developmental, sociocultural, and spiritual) contain commonly known norms
(Neuman, 2011). For example, the individual as client possesses common resources
such as organ structure and function, mental status, and coping mechanisms that
are integral to core system stability. Alternatively, the client as family has a basic
structure that includes specific roles, attitudes, and cultural beliefs that provide
energy resources and stability.
Lines of resistance protect the clients basic structure. These are defenses
activated by the client when internal or external environmental factors stress the
client system. Broken lines that circle the basic structure diagrammatically
represent these lines of resistance. The internal immune system is an example of a
physiological variable activated within the lines of resistance when infection invades
an individual. The client system restabilizes for wellness/energy conservation
(reconstitution) whenever these lines of resistance effectively mobilize internal and
external resources. Energy depletion and ultimately death occur whenever the lines
of resistance are ineffective (Neuman, 2011). Ineffective lines of resistance can be
seen when an individual has had extensive chemotherapy (an external stressor),
with the result of the immune system being severely compromised. This
compromise of the immune system is an example of system energy depletion.
Mobilization of external resources (transfusion) helps the clients internal resources
and strengthens the lines of resistance. The outcome of these added external
resources is a more physiologically stable client.
Neuman regards the normal line of defense as the usual or standard client level of
wellness that protects the basic structure as the client system reacts to stressors. A
solid line that circles the lines of resistance and basic structure represents this
protection. The standard level of wellness is achieved by the interaction of the five
variables over time. Clients usual level of wellness (the normal line of defense) is
maintained, increased, or decreased as stressed clients react to a stressor
encounter (Neuman, 2011).
The normal line of defense is encircled by the flexible line of defense,
represented by broken lines that suggest the constant interaction of the
environment and the open nature of the system. The flexible line of defense
expands and contracts depending on the protection available to the client at any
point in time. For example, healthy lifestyles and effective coping mechanisms
function as possible expanders of the flexible line of defense. Stressors may invade
the client/client system but are buffered by this line, thereby freeing clients from

reactions to those stressors. The protection of the client system is proportionate to

the distance between the flexible line of defense and the normal line of defense
(Neuman, 2011). Neuman has clarified and expanded the concept of environment to
include three discrete yet interactive environments that influence the system.
Neumans most recent publication (2011) describes how the internal and external
factors that interact with the client/client system are considered part of the
environment. The intrapersonal environment is the internal environment that
includes influences within the system. The external environment is considered both
interpersonal and extrapersonal in nature. The created environment is the third
distinct aspect of Neumans construct of environment. Neuman describes this
created environment as unconsciously developed by the client system and as a
symbolic expression of system wholeness as it mobilizes all system components
towards wellness (Neuman,1989, p. 32; 2011, p. 20).
Stressors that can influence client system stability are classified in three
ways: intrapersonal, interpersonal, and extrapersonal. First, internal stressors that
occur within the client system boundary are classified as intrapersonal.
Atherosclerosis and resultant hypertension are examples of an individual clients
intrapersonal stressors. Second, stressors that occur in the external environment
outside but proximal to the client system boundaries are classified as interpersonal.
The individual clients role in the family, perceptions of caregiver, and friend
relationships are examples of these forces. Third, extrapersonal stressors are those
that occur distally to the client boundary. Community resources, financial status,
and employment of the individual client are examples of extrapersonal stressors.
Because of the complexity of human beings, all three stressors may be exhibited in
clients and observed by nurses in any nursing situation (Neuman, 2011).
There are three different intervention modalities or nursing actions specific to
the actual or potential stressor response from the client system described by
Neuman. These interventions are dynamic and cyclical in nature and are labeled as
primary, secondary, and tertiary prevention-as-interventions. Nurses may use the
three intervention modalities concurrently to achieve a synergistic effect. Optimal
client wellness or system stability is the ultimate goal of these three interventions.
Primary interventions retain, secondary interventions attain, and tertiary
interventions maintain system energy (Neuman, 2011).
Before the client system reacts to stressors and to prevent a stressor
invasion, nursing actions should be implemented as primary prevention
interventions to strengthen the flexible line of defense. This preemptive nursing act
promotes the retention of client system wellness (Neuman, 2011). Nursing actions
such as instituting a wellness program that integrates healthy nutrition and exercise
would be an example of primary prevention-as-intervention.
Nursing actions necessary for the client system to attain restabilization
(reconstitution) through energy conservation and the use of internal and external

resources are considered secondary preventions. These interventions protect the

basic structure of the system. The nurse implements secondary prevention actions
whenever stressor reactions occur and symptoms are present. Symptom treatment
of hypertension is an example of secondary intervention. Dynamic system stability
is achieved and the basic structure is protected whenever the lines of resistance are
strengthened. Reconstitution may be viewed as feedback from the input and
output of secondary intervention (Neuman, 2011, p. 29). If secondary preventions
are not successful in reconstituting client system energy to counterbalance system
reaction, death can occur (Neuman, 2011).
After a therapeutic modality and reconstitution, the maintenance of client
system stability is achieved by tertiary prevention-as-interventions (Neuman, 2011).
Nursing actions such as education and reinforcement about nutrition, exercise, and
medications that can maintain the reconstitution of the client with hypertension are
examples of tertiary prevention.
Comprehensive assessment based on the Neuman Systems Model requires a
conceptualization of each model component (client perspective, variables, basic
structure, environmental stressors, and boundaries) by the nurse and is essential to
determine current client status accurately. The nurse-client relationship begins at
first contact and is conceived as an ongoing partnership between the nurse and
client. Through this partnership, the nurse purposefully discovers the clients
perspective and resolves any perceptual discrepancies between the nurse and
client.
Maintenance of this relationship throughout each phase of the nursing
process requires reflective, thoughtful, interactive communication by the nurse.
Systematic data collection that considers the potential or actual effect of
environmental stressors on the client system is accomplished through interview and
physical assessment (Neuman, 2011).
The Neuman Systems Model guidelines give a framework for the
development of comprehensive diagnoses, determination of appropriate
interventions, and evaluation of outcomes. For example, the nurse-client
partnership identifies a stressor that may penetrate the flexible line of defense and
lead to a variance from wellness. The nurse considers the application of relevant
nursing and related theories and in conjunction with the client develops diagnoses,
interventions, and goals to prevent or ameliorate stressor impact on the client
system. Logical outcomes are then formulated to measure client system
reconstitution (Neuman, 2011).