Basic Premise
- A range of stressors shape the system
- Each final system is a unique combination
- Line of defense (LOD) affected by inter-related variables
- Normal LOD is a baseline for health assessment
- Health and illness are dynamic combinations of variables
The model in question was introduced by Betty Neuman in the seventies of the twentieth century. Currently, it is among the most comprehensive systems used to describe holistic care. The model rests on a number of basic premises. According to the proposed model, the patients are considered systems comprised of a number of variables organized into a particular structure. The factors that shape the system include known and unknown variables that are capable of changing the state of the patient’s health (Smith & Parker, 2015). These factors are collectively referred to as line of defense (LOD) (Smith & Parker, 2015). The LOD, in its optimal state, serves as a baseline for the assessment of patient’s health. Consequently, a breach in the LOD occurs when the system is unable to oppose the external stressors. The interaction of stressors with the patient’s LOD is a dynamic and ongoing process. Therefore, illness is prevented by identifying and avoiding the risk factors (primary) or by addressing the results of the LOD breach (secondary) (Smith & Parker, 2015).
Central Concepts
- Central core: Factors responsible for a patient’s wellness
- Line of Resistance (LOR): Levels of health protection
- Prevention: Primary means of nursing intervention
- Wellness: State of harmonious interaction of LOD factors
- Illness: Breach in LOD leading to system disruption
In order to understand the Neuman’s model, it is necessary to clarify several central concepts. The combination of factors responsible for the health state of the individual is known as a central core. The core includes a number f factors that range from traditional health indicators such as body temperature and immune response to ones that constitute indirect influence. The line of resistance is an auxiliary protective system that activates in response to the breach of LOD described above. Prevention is the main means of protection of the system from the adverse effects of stressors. Finally, wellness is a state of the balanced interaction of LOD elements that prevent adverse effects of stressors, whereas illness is the opposing state, in which the protective reserves of the system are insufficient for breach prevention (Alligood, 2018).
Nursing Paradigms
- Health: Optimal state in which systems operate in harmony
- Nursing: Organized attempt to maintain wellness
- Environment: Combination of forces that influence wellness
- Person: Multidimensional being and carrier of systems
- Personal dimensions: physiological, socio-cultural, developmental, psychological, spiritual
Several nursing paradigms are relevant to the model. The first one is health (termed wellness by Neuman) – the state in which components of the system function in harmony and effectively prevent illness. Nursing is viewed as a profession aimed at assisting the patient in achieving and maintaining the state of wellness and detecting and preventing the adverse effects of stressors. Nurses develop interventions that are intended to strengthen the LOD of the patient (primary), reinforcing the LOR after the breach of LOD (secondary), and supporting LOD after illness (tertiary). The environment is an umbrella term for the stressors that impact the system. These stressors can exist within the system (internal), come from outside (external), or be developed by the patient (created). Finally, a person is a being that incorporates several subsystems, such as physiological structure, socio-cultural activities, developmental processes, psychological functions, and spiritual values (Alligood, 2018).
References
Alligood, M. R. (2018). Nursing theorists and their work (9th ed.). St. Louis, MO: Elsevier Health Sciences.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: Davis Company.